Majid Omer Waleed, Ahmed Aws Mahmood
Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Mosul, Mosul, Iraq.
Assistant Lecturer, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Mosul, Mosul, Iraq.
J Oral Maxillofac Surg. 2018 Apr;76(4):737-743. doi: 10.1016/j.joms.2017.11.028. Epub 2017 Nov 27.
The purpose of the present study was to evaluate the anesthetic adequacy of 4% articaine 1.8 mL versus 2% lidocaine 3.6 mL without palatal injection compared with the standard technique for the extraction of maxillary molar teeth.
This randomized, double-blinded, placebo-controlled clinical trial included patients requiring extraction of 1 maxillary molar under local anesthesia. Patients were randomly distributed into 1 of 3 groups: group A received 4% articaine 1.8 mL as a buccal injection and 0.2 mL as a palatal injection, group B received 4% articaine 1.8 mL plus normal saline 0.2 mL as a palatal injection, and group C received 2% lidocaine 3.6 mL plus normal saline 0.2 mL as a palatal injection. Pain was measured during injection, 8 minutes afterward, and during extraction using a visual analog scale. Initial palatal anesthesia and patients' satisfaction were measured using a 5-score verbal rating scale. Statistical analyses included descriptive statistics, analysis of variance, and Pearson χ test. Differences with a P value less than .05 were considered significant.
Eighty-four patients were included in the study. The average pain of injection was comparable among all study groups (P = .933). Pain during extraction in the articaine group was significantly less than that experienced in the placebo groups (P < .001), although the differences between placebo groups were insignificant. Satisfaction scores were significantly higher in the articaine group compared with the placebo groups (P < .001), with comparable results between placebo groups.
Although the anesthetic effects of single placebo-controlled buccal injections of 4% articaine and 2% lidocaine were comparable, the level of anesthetic adequacy was statistically less than that achieved by 4% articaine given by the standard technique. These results do not justify the buccal and non-palatal infiltration of articaine or lidocaine as an effective alternative to the standard technique in the extraction of maxillary molar teeth.
本研究旨在评估与拔除上颌磨牙的标准技术相比，不进行腭部注射时，4%阿替卡因1.8毫升与2%利多卡因3.6毫升的麻醉效果。
这项随机、双盲、安慰剂对照临床试验纳入了需要在局部麻醉下拔除1颗上颌磨牙的患者。患者被随机分为3组中的1组：A组接受4%阿替卡因1.8毫升颊部注射和0.2毫升腭部注射；B组接受4%阿替卡因1.8毫升加0.2毫升生理盐水腭部注射；C组接受2%利多卡因3.6毫升加0.2毫升生理盐水腭部注射。在注射过程中、注射后8分钟以及拔牙过程中使用视觉模拟量表测量疼痛程度。使用5分语言评定量表测量初始腭部麻醉和患者满意度。统计分析包括描述性统计、方差分析和Pearson χ检验。P值小于0.05的差异被认为具有统计学意义。
84名患者纳入本研究。所有研究组注射时的平均疼痛程度相当（P = 0.933）。阿替卡因组拔牙时的疼痛明显低于安慰剂组（P < 0.001），尽管安慰剂组之间的差异不显著。与安慰剂组相比，阿替卡因组的满意度得分显著更高（P < 0.001），安慰剂组之间的结果相当。
尽管单次安慰剂对照的4%阿替卡因和2%利多卡因颊部注射的麻醉效果相当，但麻醉充分程度在统计学上低于标准技术给予4%阿替卡因时的效果。这些结果表明，在上颌磨牙拔除中，阿替卡因或利多卡因的颊部和非腭部浸润作为标准技术的有效替代方法并不合理。
