Satilmiş Tülin, Garip Hasan, Arpaci Esra, Sener Cem, Göker Kamil
Department of Oral and Maxillofacial Surgery, Marmara University, Istanbul, Marmara, Turkey.
J Oral Maxillofac Surg. 2009 Jun;67(6):1206-10. doi: 10.1016/j.joms.2008.12.034.
The aim of this study was to assess the clinical efficacy of combined treatment with local anesthetic and subanesthetic ketamine for the relief or prevention of postoperative pain, swelling, and trismus after the surgical extraction of third molars.
Fifty patients undergoing the extraction of impacted mandibular third molars were included in the study. The patients were randomly divided into 2 groups: local anesthetic alone (LAA) and local anesthetic plus ketamine (LAK). The patients in the LAA group received 5 mL of a local anesthetic and saline combination comprising 2 mL of local anesthetic and 3 mL of saline. The patients in the LAK group received 5 mL of a local anesthetic, ketamine, and saline combination comprising 2 mL of local anesthetic and 0.3 mg/kg ketamine and saline.
Facial swelling on postoperative days was significantly lower in the LAK group than in the LAA group (P = .0001). The mouth opening on the postoperative days was significantly greater in the LAK group than in the LAA group (P = .0001). The pain scores on the VAS at 30 minutes and 1, 4, 12, and 24 hours after surgery were significantly higher in the LAA group than in the LAK group (P = .0001, P = .005).
The combination of a local anesthetic and subanesthetic doses of ketamine during surgical extraction of third molars can produce good local anesthesia while affording a comfortable procedure for the surgeon and patient and providing good postoperative analgesia with less swelling and significantly less trismus.
本研究旨在评估局部麻醉药与亚麻醉剂量氯胺酮联合治疗在缓解或预防第三磨牙手术拔除术后疼痛、肿胀和牙关紧闭方面的临床疗效。
本研究纳入了50例接受下颌阻生第三磨牙拔除术的患者。患者被随机分为两组：单纯局部麻醉（LAA）组和局部麻醉加氯胺酮（LAK）组。LAA组患者接受5 mL由2 mL局部麻醉药和3 mL生理盐水组成的局部麻醉药与生理盐水混合液。LAK组患者接受5 mL由2 mL局部麻醉药、0.3 mg/kg氯胺酮和生理盐水组成的局部麻醉药、氯胺酮与生理盐水混合液。
LAK组术后面部肿胀明显低于LAA组（P = .0001）。LAK组术后张口度明显大于LAA组（P = .0001）。术后30分钟及1、4、12和24小时，LAA组的视觉模拟评分（VAS）疼痛评分明显高于LAK组（P = .0001，P = .005）。
在第三磨牙手术拔除过程中，局部麻醉药与亚麻醉剂量氯胺酮联合使用可产生良好的局部麻醉效果，同时为外科医生和患者提供舒适的手术过程，并提供良好的术后镇痛效果，肿胀更少，牙关紧闭明显减轻。
