Franz-Montan Michelle, Silva André L R, Cogo Karina, Bergamaschi Cristiane de C, Volpato Maria C, Ranali José, de Paula Eneida, Groppo Francisco C
Department of Physiological Sciences, Dentistry School of Piracicaba, Piracicaba, SP, Brazil.
Anesth Analg. 2007 Jun;104(6):1528-31, table of contents. doi: 10.1213/01.ane.0000262040.19721.26.
The elimination of pain caused by needle insertion for local anesthesia would be a significant advance in dentistry.
In this blinded cross-over study we evaluated the efficacy of liposome-encapsulated ropivacaine for topical anesthesia. Thirty healthy volunteers received 60 mg topical anesthetics: Liposome-encapsulated 1% ropivacaine, 1% plain ropivacaine, 2.5% lidocaine and 2.5% prilocaine mixture (EMLA), and 20% benzocaine gel, in the buccal fold of the upper-right canine for 2 min in different sessions. After insertion of 30-G needles, pain was rated on a visual analog scale (VAS). A pinprick test was used to measure the duration of topical anesthesia. The pulpar response was assessed by an electric pulp tester.
VAS median and interquartile range (in cm) were 0.8 (0.4-1.5), 1.6 (0.8-2.6), 1.1 (0.3-2.7), 2.2 (0.9-2.9) for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. The liposome-encapsulated ropivacaine group showed lower VAS mean values when compared with the benzocaine group (P = 0.0205). The median values and interquartile range for the duration of soft tissue anesthesia were 11 (7-14), 6.5 (4-11), 14 (11-16), and 7 (6-9) min for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. EMLA and liposome-encapsulated ropivacaine were just as efficient for reducing pain, and showed longer soft tissue anesthesia when compared to the other local anesthetics (P = 0.0001).
Liposomal-encapsulated 1% ropivacaine gel was equivalent to EMLA for reducing pain during needle insertion and for the duration of soft tissue anesthesia. None of the topical anesthetics was effective for inducing pulpal anesthesia.
消除局部麻醉时针刺引起的疼痛将是牙科领域的一项重大进展。
在这项双盲交叉研究中，我们评估了脂质体包裹的罗哌卡因用于局部麻醉的效果。30名健康志愿者在不同时间段于右上尖牙颊侧龈颊沟处接受60毫克局部麻醉剂：脂质体包裹的1%罗哌卡因、1%普通罗哌卡因、2.5%利多卡因和2.5%丙胺卡因混合物（复方利多卡因乳膏）以及20%苯佐卡因凝胶，持续2分钟。插入30G针头后，采用视觉模拟评分法（VAS）对疼痛进行评分。采用针刺试验测量局部麻醉的持续时间。通过牙髓电活力测试仪评估牙髓反应。
脂质体包裹的罗哌卡因组、罗哌卡因组、复方利多卡因乳膏组和苯佐卡因组的VAS中位数及四分位间距（单位：厘米）分别为0.8（0.4 - 1.5）、1.6（0.8 - 2.6）、1.1（0.3 - 2.7）、2.2（0.9 - 2.9）。与苯佐卡因组相比，脂质体包裹的罗哌卡因组的VAS平均值更低（P = 0.0205）。脂质体包裹的罗哌卡因组、罗哌卡因组、复方利多卡因乳膏组和苯佐卡因组软组织麻醉持续时间的中位数及四分位间距分别为11（7 - 14）分钟、6.5（4 - 11）分钟、14（11 - 16）分钟和7（6 - 9）分钟。复方利多卡因乳膏和脂质体包裹的罗哌卡因在减轻疼痛方面效果相当，与其他局部麻醉剂相比，它们的软组织麻醉持续时间更长（P = 0.0001）。
脂质体包裹的1%罗哌卡因凝胶在减轻针刺疼痛和软组织麻醉持续时间方面与复方利多卡因乳膏相当。没有一种局部麻醉剂能有效诱导牙髓麻醉。
