Initial Injection Pressure for Dental Local Anesthesia: Effects on Pain and Anxiety

Kudo, M

doi:10.2344/0003-3006(2005)52[95:iipfdl]2.0.co;2

Cited by 75 publications

(60 citation statements)

References 6 publications

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“…4 The Wand injection system creates a 9,21 In our study, the slow rate was used for the Wand local anaesthetic system. Therefore, Wand injections might be less painful than syringe injections for IAN blocks.…”

Section: Discussionmentioning

confidence: 99%

“…2 Fear and anxiety associated with local anaesthesia injection can be a major impediment to dental care because it frequently causes patients to delay or even avoid treatment. 3 To minimise the pain on injection, the use of topical anaesthesia, low-pressure injection, 4 narrow sharp needles, 5 a slow injection rate 6 and solutions that are warmed 7 and buffered 8 have been suggested. Nevertheless, a totally painless injection is impossible to achieve under all circumstances.…”

Section: Introductionmentioning

confidence: 99%

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Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

2008

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

2008

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“…The majority of the literature on the Wand has dealt with the pain of injection with the Wand compared to that of standard injections using a syringe. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In general, the results have been favorable 18,[23][24][25][26][27][28][29][30]32,33 with the Wand, with 2 studies showing no difference 20,21,31 and 1 study showing higher pain ratings 22 with the Wand. However, the system does not produce a painless injection.…”

Section: Discussionmentioning

confidence: 99%

“…However, the system does not produce a painless injection. 17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] Further research needs to address ways to reduce pain during anesthetic solution deposition.…”

Section: Discussionmentioning

confidence: 99%

The Effects of a 2-Stage Injection Technique on Inferior Alveolar Nerve Block Injection Pain

Nusstein¹,

Steinkruger²,

Reader³

et al. 2006

Anesthesia Progress

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The purpose of this prospective, randomized, single-blinded, crossover study was to compare the pain of a traditional 1-stage inferior alveolar nerve (IAN) block injection to a 2-stage IAN block technique. Using a crossover design, 51 subjects randomly received, in a single-blinded manner, either the traditional IAN block or the 2-stage IAN block in 2 appointments spaced at least 1 week apart. For the 2-stage injection, the needle was inserted submucosally and 0.4 mL of 2% lidocaine with epinephrine was slowly given over 1 minute. After 5 minutes, the needle was reinserted and advanced to the target site (needle placement), and 1.8 mL of 2% lidocaine with epinephrine was deposited. For the traditional IAN block, following needle penetration, the needle was advanced while depositing 0.4 mL of 2% lidocaine with epinephrine (needle placement) and then 1.8 mL of 2% lidocaine with epinephrine was deposited at the target site. A Heft-Parker visual analogue scale was used to measure the pain of needle insertion, needle placement, and anesthetic solution deposition. There were no significant differences, as analyzed by Wilcoxon matchedpairs signed-ranks test, between needle insertion and solution deposition for the 2 techniques in men or women. However, there was significantly less pain with the 2-stage injection for needle placement in women. In conclusion, the 2-stage injection significantly reduced the pain of needle placement for women when compared to the traditional IAN technique.Key Words: Injection pain; Inferior alveolar nerve block; Lidocaine.T he injection of anesthetic solution for the inferior alveolar nerve (IAN) block has 3 phases: initial needle insertion through the alveolar mucosa, needle placement to the target site, and deposition of the anesthetic solution at the target site.The inferior alveolar nerve block has been associated with pain and discomfort. For the needle insertion phase, Nusstein and Beck, 1 in a retrospective study of 1635 IAN blocks, reported an incidence of moderate to severe pain ranging from 14 to 22%. For the deposition of the anesthetic solution at the target site, various authors 2-5 have reported that the incidence of moderate to severe pain ranged from 20 to 40%. Therefore, it would be advantageous to decrease the pain of the inferior alveolar nerve block.The 2-stage injection has been suggested by Walton and Torabinejad 6 and Levine 7 as a way to decrease the pain of injection. This method involves initial placement of anesthetic solution just under the mucosal surface. After a wait of several minutes for regional numbness, the injection is resumed and the remaining anesthetic solution is deposited at the target site. No clinical studies have addressed the 2-stage injection technique to reduce the pain of injection.The purpose of this prospective, randomized, singleblinded, crossover study was to compare the pain of a conventional inferior alveolar nerve block injection to that of a 2-stage inferior alveolar nerve block technique.

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“…The possible explanation of this higher amount is that the injection pressure of local anesthesia causes pain due to several factors influence pressure including volume injected into tissue per unit time, permeability of the injected solution into bone, soft tissue, blood vessels, and effects of tissue pressure and stretching of the movable mucosa caused by volume of injected solution. [27] The pain and fear of pain are positively related to stress both during pain and in the anticipation of pain so that the fear of pain would be related to higher stress and pain intensity and to reduce placebo analgesia. [28] CgA is considered a biomarker of acute stress which causes activation of sympatho-adreno -medullary system and releases of CgA which has half life of 15-20 minutes.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Effects of Local Anesthesia and its Possible Correlation with Chromogranin A

Al-Saffar¹,

Al–Sandook²,

Taha³

2014

AJPS

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Aim: To study the effects of local anesthesia on blood pressure in patients undergo extraction of maxillary teeth under infiltration local anesthesia and to compare the level of salivary chromogranin A before and after administration of local anesthesia and its possible correlation with hemodynamic effects of local anesthesia. Materials and Methods: A total of 26 patients (18 female, 8 male) who need tooth extraction under infiltration local anesthesia were examined in two situations (pre and post local anesthetic administration). For each patient salivary sample was collected by salivette to estimate the level of chromogranin A using ELISA Kits. For all patients, the blood pressure and pulse rate were measured before and after administration of local anesthesia using automatic blood pressure recorder. Results: the results showed significant differences between salivary chromogranin A for patients before the administration of local anesthesia (580.33 ± 130.42) ng/ml and after the administration of local anesthesia (674.51+ 130.93) ng/ml with p < 0.05. The results also showed that the mean value of blood pressure (systolic and diastolic blood pressure) lowered after administration of local anesthesia but with no significant differences (p > 0.05) with pre -local anesthetic value. The pulse rate was increase in it is value after local anesthetic administration with a significant differences (p < 0.05) than pre -anesthetic value. Conclusions: tooth extraction and administration of infiltration local anesthesia caused hypotension with no significant effect (p > 0.05) while it caused increase in pulse rate with a significant effect (p < 0.05). Administration of infiltration local anesthesia caused significant effects on salivary chromogranin A levels, also this study showed that there was significant inverse correlation between systolic blood pressure and chromogranin A levels(p < 0.05) after administration of infiltrations local anesthesia during dental treatments (tooth extraction).

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Initial Injection Pressure for Dental Local Anesthesia: Effects on Pain and Anxiety

Cited by 75 publications

References 6 publications

Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

The Effects of a 2-Stage Injection Technique on Inferior Alveolar Nerve Block Injection Pain

Hemodynamic Effects of Local Anesthesia and its Possible Correlation with Chromogranin A

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