Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial.

OBJECTIVE: Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. MATERIALS AND METHODS: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. RESULTS: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p<0.001), with a longer duration for the traditional method of anesthesia (median of 40 minutes). CONCLUSIONS: The two anesthetics methods did not differ concerning the pain experienced during anesthesia. Latency lasted 2 minutes for all subjects; the traditional infiltration anesthesia resulted in a longer anesthetic duration compared with the needleless jet injection.

Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial

Abstract Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. Materials and Methods: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. Results: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p<0.001), with a longer duration for the traditional method of anesthesia (median of 40 minutes). Conclusions: The two anesthetics methods did not differ concerning the pain experienced during anesthesia. Latency lasted 2 minutes for all subjects; the traditional infiltration anesthesia resulted in a longer anesthetic duration compared with the needleless jet injection.

Comparação das propriedades anestésicas em duas técnicas anestésicas distintas para molares inferiores / Comparison of anesthesic properties in two distincts anestehesic techniques for inferior molars

Introdução: O medo de sentir dor é um dos principais motivos pelos quais muitos pacientes evitam submeter-se a tratamento dentário. Em vários procedimentos odontológicos, o uso de anestésicos locais se faz necessário. O aparelho Morpheus® propõe a introdução da agulha sem dor e anestesia satisfatória, com uso de menor volume de anestésico local. Quando há necessidade de intervenção em molares e pré-molares inferiores, é preconizado o uso deste aparelho para técnica intrasseptal CaZOE, substituindo o bloqueio do nervo alveolar inferior tradicional (BNAI). Objetivo: O presente trabalho de pesquisa configurou-se como um estudo randomizado, duplo cego e cruzado, cujo objetivo foi avaliar as propriedades anestésicas através da técnica intrasseptal CaZOE e da técnica convencional do bloqueio do nervo alveolar inferior (BNAI). Material e método: Os procedimentos anestésicos foram realizados em duas sessões, por um único operador previamente treinado. Assim, foram avaliados parâmetros físicos, saturação periférica de O2, ansiedade, sensibilidade dolorosa, eficácia, tempo de latência e duração da anestesia em cada uma das técnicas, sendo então os respectivos dados comparados. Resultado: Não houve diferenças significativas quanto aos parâmetros físicos e à saturação periférica de O2. A técnica intrasseptal CaZOE apresentou maior taxa de sucesso anestésico, menor tempo de latência, menor tempo de duração e menor desconforto na execução, quando comparada ao BNAI. Conclusão: Inserir a injeção eletrônica na rotina da clínica odontológica pode proporcionar maior conforto aos pacientes submetidos à anestesia local e diminuir o abandono dos tratamentos odontológicos por medo e ansiedade associados à anestesia local.

Introduction: The fear of pain is one of the main reasons why many patients avoid undergoing dental treatment. In many dental procedures, the use of local anesthetics is necessary. Morpheus® system, which began to be marketed in Brazil in 2005, provides insertion of the needle painlessly and satisfactory anesthesia with lower volume of local anesthetic. When there is need for intervention in molars and premolars, advocated the use of this device to intrasseptal CaZOE technical replacing traditional inferior alveolar nerve block (IANB). Objective: This research work treated in a randomized duble-blind, and crossover, whose objective was to evaluate the anesthetic properties by intrasseptal CaZOE technical and traditional inferior alveolar nerve block (IANB). Material and method: The study was be conducted in two sessions. The procedures were be performed by a single operator previously trained. Physical parameters were evaluated, O2 saturation, anxiety, pain sensitivity, efficiency, latency and duration of anesthesia as compared to each of the techniques. Result: There were no significant differences in the physical parameters and the O2 saturation, the intrasseptal technical CaZOE showed greater success, shorter latency and shorter duration compared to IANB, and shorter perception painful at execution when compared to IANB. Conclusion: Inserting the electronic injection in routine dental clinic provide greater comfort to patients undergoing local anesthesia and decrease the abandonment of dental treatments for fear and anxiety associated with local anesthesia.

Levobupivacaine induces vasodilatation, but not vasoconstriction, in rat mesenteric artery / Levobupivacaína induz vasodilatação, mas não vasoconstrição em artéria mesentérica de rato

Introduction: Levobupivacaine (LEVO) can replace analgesia because it exhibits low toxicity and causes minor vasoconstriction, enabling its use in patients in whom vasoconstrictors are contraindicated. Objective: We aimed to evaluate the effects of LEVO in isolated rat superior mesenteric artery by using the vascular reactivity technique and compare its effect to that of lidocaine. Material and method: Arterial rings were obtained from the mesenteric artery of male Wistar rats and kept in organ baths. For recording isometric contractions, each ring was suspended by cotton threads from a force transducer, which was connected to a data acquisition system. Result: Both lidocaine and LEVO did not show a vasoconstrictor effect on the basal tone of the arterial rings with functional endothelium. However, when the rings were pre-contracted with phenylephrine, both drugs were able to induce concentration-dependent vasodilatation. The vasodilator effect induced by LEVO did not change after removal of the endothelium, or with the addition of tetraethylammonium (1 mM), a non-selective K+ channel blocker. In the rings without functional endothelium, which were pre-contracted with depolarizing Tyrode's solution (KCl 80 mM), LEVO-induced vasodilatation was not significantly different from that observed in the rings pre-contracted with phenylephrine. Moreover, it did not show a significant additional vasodilator effect compared to the maximal vasodilator effect of nifedipine. Conclusion: This study demonstrated that LEVO produces a vasodilator effect in the rat superior mesenteric artery in an endothelium-independent manner. This effect seems to be mediated via Ca2+ channel blockade in the vascular smooth muscle cells.

Introdução: Levobupivacaína pode ser uma nova alternativa para analgesia por apresentar baixa toxicidade e vasoconstrição, permitindo sua utilização em pacientes que apresentam contra-indicação no uso de vasoconstritores. Objetivo: Avaliar os efeitos da levobupivacaína utilizando a técnica de reatividade vascular em artéria mesentérica isolada de rato e comparar este efeito à lidocaína. Material e método: Anéis foram obtidos da artéria mesentérica de ratos machos Wistar e foram mantidos em cubas. Para o registro das contrações isométricas, cada anel foi suspenso por linhas de algodão fixadas a um transdutor de força acoplado a um sistema de aquisição. Resultado: Tanto a lidocaína como a levobupivacaína não apresentaram efeito vasocontritor sobre o tônus basal em anéis com endotélio functional. No entanto, quando os anéis foram pré-contraídos com fenilefrina, ambas as drogas induziram um vasorrelaxamento concentração-dependente. O efeito vasorrelaxante causado pela levobupivacaína não foi diferente após a remoção do endotélio, ou com o tetraetilamônio (1mM), um bloqueador não seletivo dos canais para. K+. Em anéis sem endotélio funcional e pré-contraídos com solução despolarizante de Tyrode (KCl 80mM), o vasorelaxamento induzido pela levobupivacaína não foi significativamente diferente daquele observado em anéis pré-contraídos com fenilefrina e não apresentou um efeito adicional significativo sobre o relaxamento máximo da nifedipina. Conclusão: Este estudo demonstrou que a levobupivacaína produz efeito vasorrelaxante em artéria mesentérica de rato, que é endotélio independente. Este efeito parece envolver os bloqueadores de canais para Ca2+ em célula muscular vascular lisa.

Avaliação dos efeitos da ropivacaína sobre a reatividade vascular em artéria mesentérica de rato / Assessment of the effects of ropivacaine on vascular reactivity in rat mesenteric artery

Introdução: A ropivacaína (ROPI) é um anestésico local de longa duração de ação, introduzido mais recentemente em Medicina, mas ainda não disponível para uso odontológico em tubetes. Estudos clínicos e com animais confirmam que a ROPI é um anestésico local eficaz e que possui um efeito vasoconstritor intrínseco. Objetivo: Avaliar os efeitos da ROPI sobre a reatividade vascular em artéria mesentérica isolada de rato, além de comparar esse efeito ao da lidocaína (LIDO) e avaliar o possível envolvimento do endotélio vascular na resposta induzida pela ROPI em anel de artéria mesentérica isolada de rato. Material e Método: Foram utilizados 14 ratos Wistar machos (250-300g). Os animais foram eutanasiados e, através de uma incisão no abdome do animal, foi retirada a artéria mesentérica. Desta artéria, foram obtidos anéis (1-2 mm), que foram mantidos em cubas contendo 10 mL de solução nutritiva de Tyrode mantida a 37 °C e gaseificada com carbogênio. Para o registro das contrações isométricas, cada anel foi suspenso, por linhas de algodão, a um transdutor de força conectado a um sistema de aquisição. RESULTADO: Tanto a LIDO como a ROPI não apresentaram efeito vasoconstritor sobre o tônus basal de anéis com endotélio funcional. Porém, quando os anéis foram pré-contraídos com fenilefrina, ambas as drogas foram capazes de induzir vasorrelaxamentos dependentes da concentração (Emáx = 31,7 ± 3,3%; n = 6, para a LIDO; Emáx = 69 ± 8%; n = 6, para a ROPI), que não foram alterados após a remoção do endotélio (Emáx = 28,7 ± 1,3%; n = 7, para a LIDO; Emáx = 58,8 ± 5,9%; n = 6, para a ROPI). Em anéis sem endotélio ...

Introduction: Ropivacaine (ROPI) is a local anesthetic of long duration of action, more recently introduced in medicine, however is not available for dental use in tubes yet. Clinical and animal studies have confirmed that bupivacaine is an effective anesthetic that also has an intrinsic vasoconstrictor effect. Objective: To evaluate the effects of ropivacaine on vascular reactivity in isolated rat mesenteric artery, compare this to the effect of lidocaine (LIDO) and evaluate the possible involvement of the vascular endothelium induced by ROPI in isolated rat mesenteric artery ring response. Material and Method: It was used 12 male Wistar rats (250-300g). The animals were euthanized and through an incision in the abdomen of the animal, the mesenteric artery was removed. Artery rings (1-2 mm) were obtained by the mesenteric artery, which were kept in vats containing 10 ml of Tyrode's nutrient solution kept at 37 °C and gassed with carbogen. For the recording of isometric contractions, each ring was suspended by cotton lines to a force transducer connected to a data acquisition system. RESULT: Both the LIDO as ROPI showed no vasoconstrictor effect on the basal tone of rings with functional endothelium. However, when the rings were precontracted with phenylephrine, both drugs were able to induce concentration-dependent vasorelaxation (Emax = 31.7 ± 3.3%, n = 6 for LIDO and 69 ± 8%, n = 6 for ROPI) that were not altered after removal of the endothelium (Emax = 28.7 ± 1.3%, n = 7 for LIDO and Emax = 58.8 ± 5.9%, n = 6 for ROPI). In rings without functional endothelium and precontracted with depolarizing Tyrode solution (80 mM KCl), the LIDO-induced vasorelaxation was no significantly changed (Emax = 29 ± 3%, n = 7). However, ROPI-induced vasorelaxation was reduced in this protocol and the presence of 1 mM tetraethylammonium (TEA) (Emax = 21.2 ± 5.1%, n = 7 and Emax = 17.4 ± 3.7, n = 4, ...

Comparação da latência anestésica de Articaína, Lidocaína, Levobupivacaína e Ropivacaína através de 'Pulp Tester' / Comparison of the anesthetic latency of Articaine, Lidocaine, Levobupivacaine and Ropivacaine, through "Pulp Tester"

Introdução: Um conhecimento profundo dos anestésicos odontológicos, como o tempo de latência da droga, pode assegurar o êxito do controle da dor no trans e no pós-operatório. Objetivo: Comparar a latência entre quatro soluções anestésicas, ou seja, o tempo entre o início da deposição do anestésico local e o momento em que seus efeitos tornam-se perceptíveis. Entretanto, isso não está relacionado com o êxito do controle da dor no trans e no pós-operatório (profundidade da anestesia). Material e Método: Foi realizado um estudo duplo cego, cruzado e randomizado, com 30 pacientes voluntários submetidos a quatro procedimentos em intervalos de uma semana, a partir de bloqueio do alveolar superior posterior. No segundo molar a ser tratado, foi utilizado o 'pulp tester' em intervalos de 2 minutos, considerando a insensibilidade da polpa quando da ausência de resposta após dois testes consecutivos de 80muV, chegando ao máximo de 10 minutos e determinando, assim, o período de latência do anestésico. Os dados foram submetidos aos testes T-student, de Friedman e de Kruskal-Wallis (p<0,05). Resultado: Não houve diferenças estatisticamente significativas (p=0,8327) entre as soluções anestésicas. Para todas estas, a mediana foi 2 minutos. Não houve, ainda, diferenças significantes entre os gêneros em relação à idade (p=0,4545), bem como entre os valores, quando se tentou observar a influência do gênero nos valores de latência (p=0,6754). Conclusão: Sendo os tempos médios de latência idênticos, a escolha da droga dependerá da duração do procedimento cirúrgico-odontológico a se realizar, além da necessidade ou não de analgesia pós-operatória. .

Introduction : A thorough knowledge of dental anesthetics, like the lag time of the drug, can ensure the success of pain control during and after surgery. Objective : Comparing the latency time of 4 anesthetics, in other words, the time between the deposition of the local anesthetic and when its effects become noticeable. However, this is not related with the successful pain control during and after surgery (depth of anesthesia). Material and Method : We conducted a double-blind, crossover, randomized study with 30 volunteers underwent 04 procedures in one-week intervals from the posterior superior alveolar block. In the second molar being treated, the pulp tester was used at intervals of 02 minutes, considering the insensitivity of the pulp when there is no response after two consecutive tests of 80muV, peaking at 10 minutes thus determining the latency period of the anesthetic. The data were submitted to t-student test, Friedman test and Kruskal-Wallis test (p<0.05). Result : There were no statistically significant differences (p=0.8327) between the anesthetics. In all cases the median was 2 minutes. Still, there were no significant differences between genders in relation to age (p=0.4545), as well as between the values when it attempted to observe the influence of gender in latency values (p=0.6754). Conclusion : Since the average lag time was identical, the choice of the drug will depend on the duration of the oral surgery and the necessity of postoperative analgesia. .