Surgical preparation: anesthesia & hemostasis

Abstract

The intra‐operative control of pain and hemorrhage represents significant factors that are required for modern, effective, and efficient endodontic surgical procedures. This review focuses on these important issues and emphasizes the level of clinical evidence of various studies reporting on interventions to alter pain or hemorrhage. To accomplish this goal, the review will provide an overview of the fundamental properties of local anesthetics and hemostasis and then build upon this foundation to provide evidence‐based recommendations for treatment considerations.

Strategies for managing pain during endodontic treatment

“…Patients who present with moderate to severe pain are five times more likely to experience moderate–severe operative and post‐operative pain , even if ideal treatment is provided. In addition, patients who experience pain during treatment (such as when local anaesthesia is inadequate) are more likely to have post‐operative pain . Hence, clinicians should advise their patients regarding post‐operative pain management when treating painful conditions such as irreversible pulpitis.…”

“…First, patients desire and expect that their treatment should be free of discomfort. Second, good intra‐operative pain control helps to reduce post‐operative pain and simplifies its management. Third, patients will be reluctant to have further root canal treatment in the future if they have had a bad experience as a result of pain during treatment.…”

Surgical endodontics: past, present, and future

“…Failure to obtain good hemostasis prior to tissue incision will make it very difficult to visualize the surgical site and to use moisture-susceptible root-end filling materials. While local hemostatic agents can be used once the surgical site has been accessed, they may not always be beneficial as compared to achieving the hemostasis with the initial anesthetic administration (1,13,(132)(133)(134)(135)(136).…”

“…Profound anesthesia is essential for all procedures and should provide a pain‐free environment for the duration of the procedure . Procedures should be performed within a specific time frame (usually within 60–90 mins) to prevent loss of anesthesia in addition to loss of local hemostasis .…”

Endodontic surgery

“…Lignocaine (lidocaine), combined with a vasoconstrictor, most commonly 1:80,000 adrenaline (epinephrine) in the local anaesthetic solution should fulfil these objectives. 17 Felypressin, a non-catecholamine vasoconstrictor is less effective than adrenaline in achieving adequate haemostasis and should be avoided.…”