Kramp L F, Eleazer P D, Scheetz J P
Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville, Kentucky 40292, USA.
Anesth Prog. 1999 Spring;46(2):52-5.
This investigation evaluated the use and efficacy of prilocaine HCl (4% plain Citanest) for minimizing pain associated with the intraoral administration of local anesthesia. Clinical anecdotes support the hypothesis that prilocaine without a vasoconstrictor reduces pain during injection. To determine relative injection discomfort, use of 4% plain prilocaine was compared with use of 2% lidocaine with 1:100,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin. Prior to routine endodontic procedures, 150 adult patients received 0.3 to 1.8 mL of local anesthetic via the same gauge needle without the use of a topical local anesthetic. Injection methods included buccal infiltration, labial infiltration, palatal infiltration, and inferior alveolar nerve block. Following each injection, patients were asked to describe the level of discomfort by scoring on a visual analog scale of 1 to 10, where 1 = painless and 10 = severe pain. Analyses via 2-way analysis of variance revealed no interaction between anesthetic and site of injection. However, there were statistically significant differences among the injection sites. Post hoc analysis revealed that prilocaine was associated with significantly less pain perception when compared to mepivacaine and lidocaine. These results suggest that differences in initial pain perception during transmucosal injection may be a function of the local anesthetic use, and prilocaine can produce less discomfort than the others tested.
本研究评估了盐酸丙胺卡因（4% 单纯赛罗卡因）在减轻口腔局部麻醉相关疼痛方面的使用情况及疗效。临床轶事支持了这样的假设，即不含血管收缩剂的丙胺卡因可减轻注射过程中的疼痛。为确定相对注射不适感，将 4% 单纯丙胺卡因的使用情况与 2% 利多卡因加 1:100,000 肾上腺素以及 2% 甲哌卡因加 1:20,000 左旋去甲肾上腺素的使用情况进行了比较。在进行常规牙髓治疗前，150 名成年患者通过同一规格的针头接受了 0.3 至 1.8 mL 的局部麻醉剂，未使用局部表面麻醉剂。注射方法包括颊部浸润、唇部浸润、腭部浸润和下牙槽神经阻滞。每次注射后，要求患者通过在 1 至 10 的视觉模拟量表上评分来描述不适程度，其中 1 表示无痛，10 表示剧痛。通过双向方差分析进行的分析显示，麻醉剂与注射部位之间不存在交互作用。然而，注射部位之间存在统计学上的显著差异。事后分析显示，与甲哌卡因和利多卡因相比，丙胺卡因引起的疼痛感觉明显较轻。这些结果表明，经黏膜注射时初始疼痛感觉的差异可能是局部麻醉剂使用的一个函数，并且丙胺卡因产生的不适感比其他测试药物更少。
