An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block

A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. The current article details anomalous morphology of inferior alveolar nerves encountered during routine dissection of the craniofacial region in the Gross Anatomy laboratory. We also report variations of the lingual nerves, associated with the inferior alveolar nerves. The variations were documented and a thorough review of literature was carried out. We focus on the variations themselves, and the clinical implications that these variations present. Thorough understanding of variant anatomy of the lingual and inferior alveolar nerves may determine the success of procedural anesthesia, the etiology of pathologic processes, and the avoidance of surgical misadventure.

Section: Discussionmentioning

confidence: 99%

Variant Inferior Alveolar Nerves and Implications for Local Anesthesia

Wolf

Brokaw

Bell

et al. 2016

“…Eighteen percent to 32% of the subjects rated the pain as moderate and 4% rated the pain as severe for both techniques (Table). Previous studies [2][3][4][5] of the 1-stage technique have reported an incidence of moderate to severe pain ranging from 20 to 40% using 2% lidocaine with 1 : 100,000 epinephrine. Apparently there was not a sufficient amount of anesthetic solution present to completely eliminate the pain of solution deposition with the 2-stage technique.…”

Section: Discussionmentioning

confidence: 99%

The Effects of a 2-Stage Injection Technique on Inferior Alveolar Nerve Block Injection Pain

Nusstein¹,

Steinkruger²,

Reader³

et al. 2006

Self Cite

The purpose of this prospective, randomized, single-blinded, crossover study was to compare the pain of a traditional 1-stage inferior alveolar nerve (IAN) block injection to a 2-stage IAN block technique. Using a crossover design, 51 subjects randomly received, in a single-blinded manner, either the traditional IAN block or the 2-stage IAN block in 2 appointments spaced at least 1 week apart. For the 2-stage injection, the needle was inserted submucosally and 0.4 mL of 2% lidocaine with epinephrine was slowly given over 1 minute. After 5 minutes, the needle was reinserted and advanced to the target site (needle placement), and 1.8 mL of 2% lidocaine with epinephrine was deposited. For the traditional IAN block, following needle penetration, the needle was advanced while depositing 0.4 mL of 2% lidocaine with epinephrine (needle placement) and then 1.8 mL of 2% lidocaine with epinephrine was deposited at the target site. A Heft-Parker visual analogue scale was used to measure the pain of needle insertion, needle placement, and anesthetic solution deposition. There were no significant differences, as analyzed by Wilcoxon matchedpairs signed-ranks test, between needle insertion and solution deposition for the 2 techniques in men or women. However, there was significantly less pain with the 2-stage injection for needle placement in women. In conclusion, the 2-stage injection significantly reduced the pain of needle placement for women when compared to the traditional IAN technique.Key Words: Injection pain; Inferior alveolar nerve block; Lidocaine.T he injection of anesthetic solution for the inferior alveolar nerve (IAN) block has 3 phases: initial needle insertion through the alveolar mucosa, needle placement to the target site, and deposition of the anesthetic solution at the target site.The inferior alveolar nerve block has been associated with pain and discomfort. For the needle insertion phase, Nusstein and Beck, 1 in a retrospective study of 1635 IAN blocks, reported an incidence of moderate to severe pain ranging from 14 to 22%. For the deposition of the anesthetic solution at the target site, various authors 2-5 have reported that the incidence of moderate to severe pain ranged from 20 to 40%. Therefore, it would be advantageous to decrease the pain of the inferior alveolar nerve block.The 2-stage injection has been suggested by Walton and Torabinejad 6 and Levine 7 as a way to decrease the pain of injection. This method involves initial placement of anesthetic solution just under the mucosal surface. After a wait of several minutes for regional numbness, the injection is resumed and the remaining anesthetic solution is deposited at the target site. No clinical studies have addressed the 2-stage injection technique to reduce the pain of injection.The purpose of this prospective, randomized, singleblinded, crossover study was to compare the pain of a conventional inferior alveolar nerve block injection to that of a 2-stage inferior alveolar nerve block technique.

“…Anesthesia was considered a failure if the subject never achieved 2 consecutive 80 readings without response. 8 The third parameter was the duration of lip anesthesia, which is defined as the period from onset of anesthesia until return to normal sensation of the lip. The same person who performed the pulpal tests checked the beginning of lip anesthesia; the time to recover to normal sensation was recorded by the subjects.…”

Section: Methodsmentioning

confidence: 99%

Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

Volpato¹,

Ranali²,

Ramacciato³

et al. 2005

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