Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial

Gaur, Shivangi; Marimuthu, Madhulaxmi; Wahab, Abdul; Krishnan, Navaneetha; Ramasubbu, Subhashini

doi:10.1016/j.joms.2021.07.013

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…Preemptive analgesia refers to the concept of administration of analgesics before the onset of the painful stimulus, which can provide long-term pain relief to the patient. This hypothesis is in accordance with similar studies done before, such as those done by Steffens et al, who hypothesized that the preemptive use of 120 mg of Etoricoxib can relieve the postoperative pain after periodontal open-flap debridement surgery [23,24].…”

Section: Discussionsupporting

confidence: 92%

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study

Sharma,

George,

Krishnan

2024

Cureus

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Background and objectiveThis study aims to explore the concept of preemptive analgesia, which is the technique of administration of analgesic agents before the painful stimulus. This bridges the time gap between the onset of action of the analgesic agents and the wear-off of local anesthesia. Existing literature also brings up the concept of central sensitization, which is the hyper-activity of the nervous system in response to a noxious stimulus. Administration of preemptive analgesia prevents central sensitization and hence provides prolonged analgesia to the patient. For the benefit of this study, tab. Etoricoxib 90 mg was used as the analgesic agent.In addition, this study aims to investigate the effects of the administration of tab. Etoricoxib 90 mg 30 minutes before extraction of a single mandibular third molar on the effects of pain experienced by the patient after tooth extraction as compared to a placebo. MethodologyThis was a double-blinded, prospective, observational study. The pain experienced by 50 participants in each group was measured at 1 hour, 6 hours, 12 hours, and 24 hours postoperatively using a visual analog scale (VAS). The independent samples t-test was then conducted to evaluate the results and draw out conclusions. ResultsThe average difference in pain experienced was maximum in the first hour after the procedure. The mean VAS score reported by patients was 3.14 in the study group but was 6.40 in the control group within the first hour. This difference was reduced in the first six hours after the procedure, with the average score being 3.82 in the study and 7.16 in the control group. The difference was the least after 12 hours, with the study group experiencing a VAS score of 4.64 and controls experiencing a VAS score of 6.14. After the first 24 hours, the mean VAS score was 3.80 in the study group and 5.60 in the control group. ConclusionsPreemptive administration of tab. Etoricoxib 90 mg can reduce postextraction pain in healthy adult patients as compared to placebo tablets, with a maximum difference in pain reduction seen at the end of the first six hours (P = 0.012) and the minimum at the end of 12 hours ( P = 0.0197).

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Section: Discussionsupporting

confidence: 92%

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study

Sharma,

George,

Krishnan

2024

Cureus

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“…The studies relevant to the use of twin-mix solution are summarized in table 1. 9,10,11, 26,27,28,29,30,31,32 Bhargava D et al first proposed clinical use of the twin mix anaesthesia for mandibular nerve block in 2013 by evaluating this anaesthetic technique and the admixture of drugs through their prospective clinical randomized double-blind study to evaluate latency & efficacy of twin-mix solution & 2% lignocaine with 1:200,000 adrenaline for the transalveolar extraction of impacted mandibular third molars. 9 Gaur S et al conducted a randomized controlled trial evaluating the altered twin mix local anaesthesia using two long acting amide local anesthetic solutions: bupivacaine & ropivacaine with/without 4 mg/ml dexamethasone solution for patients undergoing 3 rd molar surgical extraction.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that the intraoperative & postoperative outcome parameters in both trial groups were better than those for the control group subjects, thereby endorsing clinical efficacy of either modified or altered twin mix solutions for use as anesthetics for the transalveolar extraction of mandibular third molars. 26 Kaushik M et al compared the effectiveness of twin mix and lidocaine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. This randomized case controlled double-blind prospective clinical study assessed anaesthetic efficacy of 2% lidocaine with 1:200,000 adrenaline with an admixture of 2% lidocaine with 1:200,000 adrenaline & 1mL solution containing 4mg dexamethasone (twin mix anesthetic solution) for inferior alveolar nerve block in patients with symptomatic mandibular molars with irreversible pulpitis.…”

Section: Discussionmentioning

confidence: 99%

Twin Mix Inferior Alveolar Nerve Anaesthesia for Transalveolar Extraction of Mandibular Third Molar Surgery: Review of Current Evidence

Bhargava

Beena

Kangloo

et al. 2021

EDJ

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Utmost recurrent surgical process executed in oral & maxillofacial surgery is transalveolar extraction (TAE) of mandibular impacted 3rd molar which consequences to surgical trauma to surrounding soft & hard tissues during the process of tooth removal. Post-operative sequalae like pain, facial swelling & sometimes trismus follow TAE. Dexamethasone is commonly used steroid post-operatively and studies have revealed clinical aids in refining patients’ quality of life (QoL). To improve the QoL after TAE of third molars, use of twin-mix anaesthesia is proposed, where a combination of local anaesthetic solution and steroid is administered as a single injection, thus, negating the requirement of additional route of administration for dexamethasone. The advantages for this technique are, solitary method for dual drug delivery, reduced sensation of sting while injecting owing to altered pH of solution, short latency period, prolonged duration of anaesthesia & amended QoL post operatively. Twin Mix inferior alveolar nerve anaesthesia is found beneficial by reducing patient discomfort and enhancing patient compliance for surgeries of the mandible.

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“…GABA is one of the major inhibitory neurotransmitters of the central nervous system causing CNS depression. Benzodiazepines have no direct agonistic activity on GABA nevertheless it boosts the effect on the action of GABA [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Efficacy of Midazolam and Dexmedetomidine As Sedative Agents in Third Molar Surgery

Jason,

Sundaram,

et al. 2023

Cureus

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Introduction Minor dental and oral surgical procedures have been made comfortable with the rise in the use of daycare sedatives. Of these sedatives, midazolam is deemed a common sedative used for minor oral surgical procedures. Newer and safer sedatives such as dexmedetomidine have certain properties that may prove more efficient in oral surgical procedures. Third molar surgery is one of the most common minor oral surgical procedures performed in dentistry. Thus, this study aims to compare the efficacy of midazolam and dexmedetomidine as sedative agents in third molar surgery. Materials and methods Sixty young adult patients free from other comorbidities were included in the study with ages ranging between 18 and 50 years. The samples were matched for the difficulty of impacted teeth and randomly distributed among the groups. Groups were administered the respective sedative drugs midazolam and dexmedetomidine and their effects were observed through the Observer’s Assessment of Alertness/Sedation scale. The intraoperative vitals and sedation effects were checked every 15 minutes. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Independent samples t-test and analysis of variance were the statistical tests employed to analyze the obtained data with p<0.05 considered as statistically significant. Results The depth of sedation has been both subjectively and objectively assessed and had no significant difference among the groups. The intra-operative heart rate assessment proved a more efficient reduction of pulse rate in the dexmedetomidine group as compared with the midazolam group. However, it was not statistically significant (p=0.121). The mean diastolic blood pressure showed a statistically significant difference between the groups with dexmedetomidine having lower blood diastolic pressure compared to midazolam (p=0.004). Quick arousal was witnessed in the dexmedetomidine group. Conclusion It can be concluded from the study that both dexmedetomidine and midazolam were equally effective as sedative agents for third molar surgery. However, the nature of cardio-protection, anti-sialagogue, and analgesic properties of dexmedetomidine can prove helpful, especially in minor oral surgical procedures like third molar surgery and it is recommended.

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Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial

Cited by 7 publications

References 33 publications

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study

Twin Mix Inferior Alveolar Nerve Anaesthesia for Transalveolar Extraction of Mandibular Third Molar Surgery: Review of Current Evidence

Comparison of the Efficacy of Midazolam and Dexmedetomidine As Sedative Agents in Third Molar Surgery

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