An evaluation of 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block

McLean, Celia; Reader, Al; Beck, Mike; Meyers, William J.

doi:10.1016/s0099-2399(06)80510-8

Cited by 114 publications

(95 citation statements)

References 15 publications

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“…14,15 McLean et al 14 and Hinkley et al 15 have reported pulpal anesthesia onset times in the first mandibular premolar ranging from 10.0 to 13.7 minutes.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

Volpato¹,

Ranali²,

Ramacciato³

et al. 2005

Anesthesia Progress

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The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacaine, both 0.5% and with 1 : 200,000 epinephrine. Before and after the injection, the first mandibular premolar was evaluated every 2 minutes until no response to the maximal output (80 reading) of the pulp tester and then again every 20 minutes. Data were analyzed using the Wilcoxon paired test and the paired t test. No differences were found between the solutions for onset and duration of pulpal anesthesia and duration of soft tissue anesthesia (P Ͼ .05). It was concluded that the solutions have similar anesthetic efficacy.Key Words: Bupivacaine; Levobupivacaine; Inferior alveolar nerve block; Anesthetic efficacy; Pulpal anesthesia. Racemic bupivacaine has been used as a local anesthetic in medicine and dentistry for many years. The 2 main indications for its use in dentistry are lengthy procedures and management of postoperative pain, as in endodontic, surgical, and periodontal procedures, among others.1 Although no case of toxicity has been documented in dentistry, a number of authors have reported its potent cardiac toxic effects, even in small doses.2 Studies that compared racemic bupivacaine and levobupivacaine have shown less toxicity for the latter. onset of action and prolonged analgesia with this solution than with other mixtures of bupivacaine enantiomers. Considering the lower toxicity of levobupivacaine, the purpose of this study was to compare the anesthetic efficacy of racemic bupivacaine and the mixture of 75% levobupivacaine and 25% dextrobupivacaine, both in the concentration of 0.5% with 1 : 200,000 epinephrine. METHODSThe Ethical Committee in Human Research at the Piracicaba Dentistry School, State University of Campinas, São Paulo, Brazil, approved this study; written consent was obtained from each subject. The sample size was based on a previous 6 study and confirmed by using the software nQuery Advisor 4.0 for Windows. Twenty-two subjects (9 men and 13 women) who ranged in age from 21 to 51 years (average age, 25 years) participated in this study. All the subjects were in good health, and none were taking any medication that would alter pain

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“…14,15 McLean et al 14 and Hinkley et al 15 have reported pulpal anesthesia onset times in the first mandibular premolar ranging from 10.0 to 13.7 minutes.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

Volpato¹,

Ranali²,

Ramacciato³

et al. 2005

Anesthesia Progress

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“…Generally, the lidocaine solution had similar rates of anesthetic success and incidences of pulpal anesthesia to those found in other studies of the IAN block. [1][2][3][4][5][6][7][8][9][10][11][12][13] The lidocaine solution did not provide complete pulpal anesthesia for the mandibular teeth (Figures 2 through 7) and could present meaningful clin- Figure 6. Incidence of lateral incisor anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the lidocaine and lidocaine/meperidine solutions.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Failure rates of 7 to 75% have been reported in experimental studies. [1][2][3][4][5][6][7][8][9][10][11][12][13] Clinical studies in endodontics [14][15][16][17][18][19][20] have found failure with the IAN block occurring between 44 and 81% of the time. Therefore, it would be advantageous to improve the success rate of the IAN block.…”

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confidence: 99%

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks

Goodman¹,

Reader²,

Nusstein³

et al. 2006

Anesthesia Progress

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The authors, using a crossover design, randomly administered, in a single-blind manner, inferior alveolar nerve blocks using 36 mg of lidocaine with 18 g of epinephrine or a combination of 36 mg of lidocaine with 18 g epinephrine plus 36 mg meperidine with 18 g of epinephrine, at 2 separate appointments, to 52 subjects. An electric pulp tester was used to test for anesthesia, in 4-minute cycles for 60 minutes, of the molars, premolars, and central and lateral incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes and the 80 reading was continuously sustained for 60 minutes. Using the lidocaine solution, successful pulpal anesthesia ranged from 8 to 58% from the central incisor to the second molar. Using the lidocaine/meperidine solution, successful pulpal anesthesia ranged from 0 to 17%. There was a significant difference (P Ͻ .05) between the lidocaine and lidocaine/meperidine solutions for the lateral incisors through the second molars. We conclude that the addition of meperidine to a standard lidocaine solution does not increase the success of the inferior alveolar nerve block.Key Words: Meperidine; Inferior alveolar nerve block; Lidocaine.T he inferior alveolar nerve (IAN) block is the most frequently used injection technique for achieving local anesthesia for mandibular restorative and surgical procedures. However, the IAN block does not always result in successful pulpal anesthesia.1-13 Failure rates of 7 to 75% have been reported in experimental studies. [1][2][3][4][5][6][7][8][9][10][11][12][13] Clinical studies in endodontics [14][15][16][17][18][19][20] have found failure with the IAN block occurring between 44 and 81% of the time. Therefore, it would be advantageous to improve the success rate of the IAN block.Meperidine was first introduced in 1939 as an analgesic, sedative, and antispasmodic agent.21 It is also known as pethidine or Demerol. Meperidine is a phen- ylpiperidine derivative of the opioids. 22,23 The molecular weight and pKa of meperidine are closer to lidocaine than other opioids. 22 Clinically, meperidine has local anesthetic activity. A number of clinical and experimental studies [24][25][26][27][28][29][30][31][32][33][34][35][36] have shown that meperidine induces spinal anesthesia and blocks action potentials, providing segmental and sensory blocks comparable to those provided by lidocaine. In medicine, it has been administered intrathecally, 22,24,28,30,32 spinally, 27,34 and as a saddle block, 25 as well as locally for intravenous regional anesthesia, 35 block, 29 and infiltration 36 for the effects of analgesia, anesthesia, or both.The exact mechanism of meperidine's local anesthetic activity is unknown. It is possible that meperidine acts peripherally through opioid-specific receptors. However, Pang and colleagues 37 found that meperidine was effective in reducing propofol injection pain, and this result was not reversible by the addition of naloxone.

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“…Unfortunately, the answer has always been, "No." 1 Traditional methods of confirming anaesthesia are usually subjective and involve verbal questioning of the patient about his/ her symptoms, or soft-tissue testing, where the response is noted to a sharp explorer. These approaches may not be effective for determining pulpal anaesthesia and provide only bimodal responses; hence they cannot detect parametric differences between anaesthetics or routes of injection.…”

Section: Commentarymentioning

confidence: 99%

Using a cold test to assess pulpal anaesthesia

Balto

2007

Evid Based Dent

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Design This was a randomised controlled trial (RCT). Intervention Groups given a true cold test (test group) or a sham cold test (control) were compared. Outcome measure If pain was experienced during the procedure, patients were asked to point to their level of pain on a visual analogue scale (VAS). Stages of the RCT were divided as follows: before entering the pulp chamber, while entering the pulp chamber, preparing the canal, irrigating the canals, and obturation of the canals. Results Unadjusted results showed 12% of test subjects experienced pain during the RCT compared with 38% of control subjects (N=83; P 0.004; power, 84%). Multiple logistic regression analysis controlled for confounders and effect-modifiers (odds ratio, 0.20; P 0.01). Subjects who had a negative response to the cold test were approximately 80% less likely to experience pain during the procedure than subjects who had only soft tissue signs of anaesthesia. Conclusions The cold test is a significantly better indicator of pulpal anaesthesia than the current standard of care, ie, using soft tissue signs alone. We strongly advocate the use of the cold test to assess pulpal anaesthesia.

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An evaluation of 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block

Cited by 114 publications

References 15 publications

Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks

Using a cold test to assess pulpal anaesthesia

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