Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery

Ping, Bushara,Kiattavorncharoen, Sirichai,Durward, Callum,Im, Puthavy,Saengsirinavin, Chavengkiat,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2015 Journal of Dental Anesthesia and Pain Medicine Vol.15 No.3

Background: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. Methods: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. Results: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). Conclusions: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

The efficacy of an elevated concentration of lidocaine HCl in impacted lower third molar surgery

Ping, Bushara,Kiattavorncharoen, Sirichai,Saengsirinavin, Chavengkiat,Im, Puthavy,Durward, Callum,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2015 Journal of Dental Anesthesia and Pain Medicine Vol.15 No.2

Background: There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. Methods: This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. Results: We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. Conclusions: Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.

Inferior alveolar nerve block by intraosseous injection with Quicksleeper^Ⓡ at the retromolar area in mandibular third molar surgery

Sovatdy, Sam,Vorakulpipat, Chakorn,Kiattavorncharoen, Sirichai,Saengsirinavin, Chavengkiat,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2018 Journal of Dental Anesthesia and Pain Medicine Vol.18 No.6

Background: There are many techniques of inferior alveolar nerve block injection (IANBI); one among them is the computer-assisted intraosseous injection (CAIOI). Here we aim to evaluate the effectiveness of CAIOI with $Quicksleeper^{(R)}$ in mandibular third molar surgery. Methods: This study is a clinical, single-blind, randomized, split-mouth, controlled trial including 25 patients (10 males and 15 females, mean age 21 years). The patients underwent surgical removal of bilateral mandibular third molars with two different IANBI techniques. One side was injected using $Quicksleeper^{(R)}$, and the other side was injected using a conventional IANBI. Both techniques used one cartridge (1.7 ml) of 1:100,000 epinephrine 4% articaine. A supplementary injection was used if necessary. All volumes of anesthetic agent used were recorded. Statistical analysis was performed using paired t-test and Wilcoxon test. Results: This research showed that CAIOI has faster onset and shorter duration of action than IANBI (P < 0.05). The pain was similar in both techniques. In the CAIOI group, one-third of the cases could be completed without additional anesthesia. The remaining two-thirds required minimal supplementary volume of anesthesia. The success rates were 68% for CAIOI and 72% for IANBI, respectively. Conclusion: CAIOI is an advantageous anesthetic technique. It can be used as an alternative to conventional IANBI for mandibular third molar surgery.

The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery

Latt, Maung Maung,Kiattavorncharoen, Sirichai,Boonsiriseth, Kiatanant,Pairuchvej, Verasak,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2016 Journal of Dental Anesthesia and Pain Medicine Vol.16 No.2

Background: Surgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery. Methods: A controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo. Results: The pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences. Conclusions: Injection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.

Single buccal infiltration of high concentration lignocaine versus articaine in maxillary third molar surgery

Phyo, Hnin Ei,Chaiyasamut, Teeranut,Kiattavorncharoen, Sirichai,Pairuchvej, Verasak,Bhattarai, Bishwa Prakash,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2020 Journal of Dental Anesthesia and Pain Medicine Vol.20 No.4

Background: This research evaluated the numbness produced by lignocaine at an equal or higher concentration than that of 4% articaine through a single point of injection for maxillary third molar surgery. This randomized double-blind study was conducted to compare the anesthetic efficiency of 4% lignocaine with that of 4% articaine in impacted maxillary third molar surgery using a single buccal infiltration alone. Methods: The study participants were 30 healthy patients requiring the bilateral surgical removal of symmetrically-positioned maxillary third molars. Using a split-mouth design, each patient randomly received buccal infiltration of 1.7 ml of 4% lignocaine and 1.7 ml of 4% articaine during two separate appointments. After 15 minutes of anesthetic injection, surgery was performed by the same surgeon using a consistent technique on both sides. Pinprick test pain scores of the buccal and palatal gingiva of the maxillary third molar after 10 minutes and 15 minutes latencies, pain scores during the surgery, the need for supplemental anesthesia, and patients' satisfaction with anesthetic efficiency were recorded. Surgery performed without supplemental anesthesia was categorized as successful. Results: The success rates of 4% lignocaine and 4% articaine (83.34% vs. 86.67%, P = 1.00) were not significantly different. Only 5 cases (4 cases in the articaine group and 1 case in the lignocaine group) reported mild pain and pressure sensation (NRS ≤ 1) on probing at the palatal side after 15 minutes of latency (P = 0.25). The pain scores of maxillary third molar surgery in the two groups were not significantly different (P > 0.05). Moreover, the statistical analysis confirmed the comparable patient satisfaction of two study groups (P = 0.284). Conclusion: This study provides evidence that single buccal infiltrations of 4% lignocaine and 4% articaine have comparable anesthetic efficacy and success rates for impacted maxillary third molar surgery. Both 4% lignocaine and 4% articaine can produce effective palatal anesthesia and pain control using buccal infiltration alone after 15 minutes of latency.

Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery

Wanithanont, Pavita,Chaiyasamut, Teeranut,Vongsavan, Kadkao,Bhattarai, Bishwa Prakash,Pairuchvej, Verasak,Kiattavorncharoen, Sirichai,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2021 Journal of Dental Anesthesia and Pain Medicine Vol.21 No.1

Background: Impacted mandibular third molar removal is one of the most commonly performed oral surgical procedures. This procedure can lead to several postoperative complications, such as trismus, facial swelling, and pain, which occur as a result of the inflammatory responses to surgery. This study compared the efficiency of preoperative injections of 4 mg versus 8 mg dexamethasone into the pterygomandibular space to reduce postoperative sequelae. Methods: This was a randomized, prospective, split-mouth, controlled study, including 52 mandibular third molar surgeries in 26 patients. Each patient was randomized to either the 4 mg or 8 mg dexamethasone injection group. Dexamethasone was injected into the pterygomandibular space after numbness from local anesthesia. Data were collected for trismus, facial swelling, visual analog scale (VAS) pain score, and the number of analgesics taken during the evaluation period. The level of significance was set at P < 0.05. Results: Statistically significant differences in postoperative facial swelling (P = 0.031, diff = 1.4 mm) and pain (P = 0.012, diff = 0.020) were found between the 8 mg and 4 mg dexamethasone groups. However, there were no significant differences between the groups for trismus and the total number of analgesics consumed (P > 0.05). Conclusion: Compared to the 4 mg preoperative dexamethasone injection, the 8 mg preoperative dexamethasone injection into the pterygomandibular space was more effective in reducing postoperative swelling and pain following the surgical removal of the impacted mandibular third molar. However, the difference in trismus could not be evaluated clinically. Therefore, the recommendation of administering the 4 mg dexamethasone preoperative injection is optimal in the third molar surgical procedure.