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The objective of this randomized double-blind investigation was to compare the anesthetic efficacy and injection discomfort of 3 volumes of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltration anesthesia. A total of 25 subjects received 0.6, 0.9, and 1.2 mL of the anesthetic buccal to an upper canine. Test teeth were assessed with electrical stimulation to determine onset and duration of pulpal anesthesia; soft tissue anesthesia and injection discomfort were assessed by pin-prick test and visual analog scale ( VAS ). Data were analyzed by 2-way analysis of variance ( ANOVA ), Friedman, and chi-square tests (a 5 5%). The 1.2 mL dose induced faster onset of pulpal anesthesia, a higher success rate, and a longer duration of soft tissue/pulpal anesthesia than were achieved with the other doses (P , .05). No differences in injection discomfort were observed between treatments. It is concluded that maxillary infiltration anesthesia with lidocaine and epinephrine has a faster onset, a greater success rate, and a longer duration when a volume of 1.2 mL is used than when volumes less than 1.0 mL are used.

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

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