Singh Virendra, Thepra Manju, Kirti Shruti, Kumar Prashant, Priya Kannu
Head, Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Rohtak, India.
Resident, Post Graduate Institute of Dental Sciences, Rohtak, India.
J Oral Maxillofac Surg. 2018 Oct;76(10):2091.e1-2091.e7. doi: 10.1016/j.joms.2018.05.037. Epub 2018 Jun 6.
The study aimed to compare the effect of dexmedetomidine added to lidocaine against epinephrine added to lidocaine on local anesthetic potency and to look for future prospects of dexmedetomidine as an additive to local anesthesia in dentistry.
The study included 25 healthy volunteers in whom extraction of all first premolars was scheduled as part of their orthodontic treatment plan. In this split-mouth, double-blind, crossover, randomized controlled trial, patients were randomized into 2 groups: Group 1 received injection lidocaine plus dexmedetomidine, and group 2 was administered lidocaine plus epinephrine. Patients were assessed for the onset of action of anesthesia, duration of analgesia, pain perception, and vital signs.
The mean values (±standard deviations) for the onset of anesthetic action in groups 1 and 2 were 113 ± 24.9 and 141 ± 34.8 seconds, respectively, for the mandible. For the maxilla, the mean values were 113 ± 24.9 seconds for group 1 and 165 ± 43.8 seconds for group 2. The duration of anesthesia was longer in group 1 (lidocaine plus dexmedetomidine), in which the requirement for the first analgesic on request was seen after a longer time interval, when compared with group 2 (lidocaine plus epinephrine). Pain perception elicited statistically significant results with less perception of pain in group 1 (lidocaine plus dexmedetomidine). The vital parameters remained stable, and the results were not statistically significant.
In this study, we observed that the addition of dexmedetomidine to lidocaine for maxillary and mandibular nerve blocks significantly prolonged the block duration and shortened the onset of action, as well as improved postoperative analgesia in terms of the need for fewer analgesics in the postoperative period. Furthermore, the vital parameters remained stable and no complications were encountered. The findings were supportive of the use of dexmedetomidine as an adjunct to local anesthetics in dental procedures.
本研究旨在比较右美托咪定添加至利多卡因与肾上腺素添加至利多卡因对局部麻醉效能的影响，并探寻右美托咪定作为牙科局部麻醉添加剂的未来前景。
本研究纳入25名健康志愿者，他们均计划拔除所有第一前磨牙作为正畸治疗计划的一部分。在这项双侧对照、双盲、交叉、随机对照试验中，患者被随机分为两组：第1组接受利多卡因加右美托咪定注射，第2组接受利多卡因加肾上腺素注射。对患者的麻醉起效时间、镇痛持续时间、疼痛感知和生命体征进行评估。
第1组和第2组在下颌骨的麻醉起效平均时间（±标准差）分别为113±24.9秒和141±34.8秒。在上颌骨，第1组的平均值为113±24.9秒，第2组为165±43.8秒。第1组（利多卡因加右美托咪定）的麻醉持续时间更长，与第2组（利多卡因加肾上腺素）相比，在更长的时间间隔后才出现首次按需镇痛的需求。疼痛感知方面，第1组（利多卡因加右美托咪定）的疼痛感知明显较低，差异具有统计学意义。生命参数保持稳定，结果无统计学意义。
在本研究中，我们观察到在上颌和下颌神经阻滞中，将右美托咪定添加至利多卡因可显著延长阻滞持续时间，缩短起效时间，并在术后减少镇痛药需求方面改善术后镇痛效果。此外，生命参数保持稳定，未出现并发症。这些发现支持右美托咪定在牙科手术中作为局部麻醉剂的辅助用药。
