The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks

Hannan, Lawrence J.; Reader, Al; Nist, Robert; Beck, Mike; Meyers, William J.

doi:10.1016/s1079-2104(99)70156-3

Cited by 75 publications

(55 citation statements)

References 17 publications

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“…[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.…”

mentioning

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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confidence: 99%

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks

Goodman¹,

Reader²,

Nusstein³

et al. 2006

Anesthesia Progress

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“…Studies have shown anesthetic success rates of 75 -97 % with peripheral nerve stimulator (36). Although Hannan et al (37) found the nerve block administered with ultrasound accurate, it did not result in a more successful pulpal anesthesia. Berns and Sandove found 25% of accurate blocks using radio-opaque dyes to result in anesthetic failure due to migration of anesthetic solution following the path of least resistance while this was determined by facial planes and structures encountered in the pterygomandibular space (38).…”

Section: Variations Of the Mandibular Nerve And Associated Complicationsmentioning

confidence: 99%

Anatomy and clinical applications of the mandibular nerve

Somayaji¹,

Acharya²,

Mohandas³

et al. 2012

BLL

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Abstract:A thorough anatomical knowledge is very essential for clinical practice and any surgical procedure. Unfortunately anatomical variations can lead to hazards in medical and dental diagnosis and treatment. Such knowledge is very essential even in effective local anesthesia which is an essential part of treatment in patients with many oral disorders. Therefore a normal anatomy and its possible variations are utmost important aspects also in dentistry. One of the structures that dentists very often deal with is the mandibular nerve which therefore needs a thorough review. However, there are not many consolidated literature reviews available regarding its variations and clinical applications. Keeping this in mind, in this article, the authors have brought together available literature on various aspects of mandibular nerve. The fi nal review will be of benefi t to clinicians (Fig. 2 A thorough anatomical knowledge is very essential for clinical practice and any surgical procedure. The idea of exact location of various structures in the body prepares the clinician for a better approach in diagnosis and intervention. Unfortunately, the anatomical variations can lead to hazards in medical and dental diagnosis and treatment. Such knowledge is very essential even in effective local anesthesia which is an essential part of treatment in patients with many oral disorders. Therefore a normal anatomy and its possible variations are utmost important aspects also in dentistry. One of the structures that dentists very often deal with is the mandibular nerve which therefore needs a thorough review. However, there are not many consolidated literature reviews available regarding its variations and clinical applications. Keeping this in mind, in this article, the authors have brought together literature available on various aspects of mandibular nerve. The fi nal review will be of benefi t to clinicians.The mandibular nerve, largest division of trigeminal nerve, supplies the mandibular teeth and gums, mucosa of the anterior two thirds of the tongue, fl oor of the oral cavity, skin of the temporal region, part of the auricle and external acoustic meatus including the tympanum, lower lip, and lower and posterior parts of the face. Developmentally, it is the post-trematic nerve of the fi rst pharyngeal arch and therefore contains the motor fi bers to the muscles developed from the fi rst pharyngeal arch. It is a mixed nerve formed by the union of a large sensory root, branch of the lower part of the trigeminal ganglion and a smaller motor root from the pons which courses under the trigeminal ganglion. Both roots exit through the foramen ovale and unite just outside the foramen to form the trunk of the mandibular nerve which descends between the tensor veli palatini and lateral pterygoid muscles, gives off a meningeal branch and the nerve to medial pterygoid branch and ends by dividing into a smaller, mostly motor anterior branch and a larger, mostly sensory posterior branch. It contains about 78,000 myelinated fi bers. The nerve...

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Section: Evaluation Of Mandibular Nerve Block: a Clinical Studymentioning

confidence: 99%

“…2 In 1884, Halsted and Hall described the first inferior alveolar regional nerve block by injecting an anesthetic solution (cocaine) into the area of the mandibular foramen.3 Then, Fischer described the classic technique that was modified later by many authors. 4 Nowadays, most of the dentists all around the world are using a technique similar to the one described by Jorgensen and Hayden in 1967, targeting the mandibular nerve.…”

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Evaluation of Mandibular Nerve Block: A Clinical Study

Jha¹

2016

IJOCR

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injection technique for achieving local anesthesia (LA) for restorative and surgical procedures. 2 In 1884, Halsted and Hall described the first inferior alveolar regional nerve block by injecting an anesthetic solution (cocaine) into the area of the mandibular foramen.3 Then, Fischer described the classic technique that was modified later by many authors. 4 Nowadays, most of the dentists all around the world are using a technique similar to the one described by Jorgensen and Hayden in 1967, targeting the mandibular nerve. 3,5 There are various studies done on different types of local anesthetics used in dentistry, the differerent techniques to block the inferior alveolar, lingual, and the long buccal nerves, but very few studies have been done on the onset of action of anesthesia, the sequence of anesthesia of the soft tissues such as lip, tongue, cheek, and chin. MAtEriAlS ANd MEthodSA total of 100 adult healthy male patients in the age group of 20 to 48 years who underwent surgical removal of the impacted mandibular 3rd molar were included in this prospective study. Written consent was obtained from all the patients. A cartridge containing 1.8 mL of 2% lignocaine with 1:80,000 epinephrine and 25 gauze needle was used in each patient. Inferior alveolar nerve block using direct technique was given. The total time taken to inject the solution in each patient was 1 minute. The whole procedure was carried out by a single operator. Out of the total 1.8 mL, 0.9 mL was injected to block the IAN; 0.6 mL was used to block the lingual nerve; and 0.3 mL was used to block the long buccal nerve. The subjective and objective signs and symptoms were assessed immediately after injection. The distribution of anesthesia, pain on injection, onset of anesthesia, and order or sequence of anesthesia, that is, time taken for anesthesia of each of the three branches of the mandibular nerve was evaluated separately in each patient. rESultSOut of the 100 patients who were given IAN block, pulpal anesthesia was achieved in all the patients. About 99% experienced lip anesthesia, 90% had tongue anesthesia, 68% had cheek anesthesia, and only 37% experienced anesthesia of the chin. Only one patient had no anesthesia of the lip, whereas ten patients had no anesthesia of the ABStrACtPurpose: Clinical evaluation of the mandibular nerve block using various parameters. Materials and methods:Inferior alveolar, lingual and long buccal branches of the mandibular nerve were blocked using 2% lignocaine hydrochloride with 1:80,000 epinephrine in a group of 100 healthy adult male patients who underwent surgical removal of impacted mandibular 3rd molar after obtaining written consent. Each of these patients was evaluated for various parameters, such as distribution of anesthesia, pain on injection, onset of action, and order of anesthesia following standard protocol. Results:Out of the 100 patients who were given mandibular nerve block, pulpal anesthesia was achieved in all the patients. About 99% of the patients experienced lip anesthesia, 90% tongue ...

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The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks

Cited by 75 publications

References 17 publications

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks

Anatomy and clinical applications of the mandibular nerve

Evaluation of Mandibular Nerve Block: A Clinical Study

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