Role of addition of dexamethasone to lignocaine 2% with adrenaline in dental nerve blocks for third molar surgery: A prospective randomized control trial

Abstract

Context:Dexamethasone has been frequently used in oral surgical procedure and accepted by oral and maxillofacial surgeon community worldwide. However, this is the first clinical trial that used dexamethasone as adjuvant with lignocaine in dental nerve block (DNB).Aims:The purpose of this double-blind, randomized control trial (RCT) was to compare the effect of dexamethasone with normal saline (NS) in a lignocaine DNB.Settings and Design:This prospective, double-blind, RCT was carried out after obtaining approval from the Institutional Ethical Committee.Subjects and Methods:In forty patients, the present placebo-controlled clinical trial was conducted; allocated randomly into two groups: study group (SG) or control group (CG). The single-dose submucosal dexamethasone or NS injection was administered immediately after 2% lignocaine with epinephrine 1:2,00,000 nerves block during mandibular third molar surgery (TMS). Visual analog scale score, number, and exact time nonsteroidal anti-inflammatory drugs were administered were used to measure postoperative analgesia in 2nd and 7th days.Statistical Analysis Used:All the data were entered into the Spreadsheet (Excel, Microsoft) and Chi-square test, Mann–Whitney U-test, Student's paired and unpaired t-test, and Fisher exact test were used.Results:This study found maximum duration of DNB in SG was 248.88 min and in CG was 175.44 min, whereas minimum duration in SG was 197 min and in CG was 140.78 min.Conclusions:Dexamethasone prolongs the action of lignocaine 2% in DNB for TMS.

Effectiveness of dexamethasone or adrenaline with lignocaine 2% for prolonging inferior alveolar nerve block: a randomized controlled trial

“…Smaller fibres are generally more susceptible to LAa because a given volume of LA solution can more readily block the requisite number of sodium channels for impulse transmission to be entirely interrupted. Moreover, several previous studies had reported a statistically significant increase in the mean duration of soft tissue anaesthesia ranging from 197 to 301 minutes (P≤0.05) when dexamethasone was administered locally into the pterygomandibular space after IANB with lignocaine 2% with adrenaline 10,35 . Unfortunately, those studies did not assess perioperative analgesia and VAS and were not well-documented.…”

“…Past studies used dexamethasone adjuvants in long- to intermediate-acting LAa and found significantly prolonged duration of action in brachial and femoral nerve blocks 19 - 26 . Although TMS has been most frequently used for postoperative acute pain studies 9 - 13 , there have not been many investigations conducted to determine the effectiveness of dexamethasone adjuvants with lignocaine in IANB. To the best of our knowledge, this study could be the first to use dexamethasone adjuvants with lignocaine in TMS.…”

“…Every year, millions of people undergo third molar surgery (TMS) and experience postoperative pain at various levels, i.e., moderate to severe in intensity 9 - 11 . TMS has become the model most frequently used for postoperative acute pain studies.…”

Local anesthesia for mandibular third molar extraction

“…However, caution is advised as the toxicity also increases [ 21 ]. Deo reported that a supplemental, submucosal injection of dexamethasone at the insertion site of the inferior alveolar nerve block prolongs the duration of anesthesia [ 22 ].…”

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

“…Study found maximum duration of DNB in study group (SG) was 248.88 min and in control group (CG) was 175.44 min. 18 In a study by Zhao et al it was found that perineural dexamethasone prolongs the analgesic duration as compared to intravenous route only when epinephrine is coadministered. Without epinephrine, the two modalities show equivalent effect as adjuvants on regional anesthesia.…”