Hameed Nithasha N, Sargod Sharan S, Bhat Sham S, Hegde Sundeep K, Bava Muhsin Mohammed
Department of Pedodontics, Yenepoya Dental College, Mangalore, Karnataka, India.
Department of Medicine, FMMCH, Mangalore, Karnataka, India.
J Indian Soc Pedod Prev Dent. 2018 Jul-Sep;36(3):296-300. doi: 10.4103/JISPPD.JISPPD_222_17.
Injection of local anesthesia is one of the most important reasons for avoidance behavior in children. Applying a topical anesthetic before injection is the most popular way to control pain; however, topical anesthetics have some shortcomings such as longer duration of action, displeasing taste, and spread of the anesthetic agent to noninjection site areas. Cryoanesthesia using refrigerant as a topical anesthesia is being studied as an alternative to overcome the shortcomings of topical anesthetics and has shown promising results.
In this split-mouth design study, 50 children of aged 8-10 years who required bilateral mandibular local anesthesia administration were selected. In the first visit, application of topical anesthetic spray (lidocaine) on one side and during the second appointment cryoanesthetic tetrafluorethane on the other side was used before local anesthetic administration. Patients were asked to report their discomfort and pain using visual analog scale (VAS) (subjective method). Patients' pain perception during injection is assessed by sound, eye, and motor (SEM) scale by the dentist (objective method).
The results were statistically analyzed using paired Wilcoxon signed-rank test and Mann-Whitney tests. In VAS scale (subjective method), pain scores were significantly lower in tetrafluorethane group when compared with lidocaine group. In SEM scale (objective method), pain scores were lower in tetrafluorethane group when compared with lidocaine group, but it was statistically insignificant.
Precooling the injection site using refrigerant tetrafluorethane spray has shown to be effective in eliminating pain before local anesthesia administration in children when compared with topical anesthetic lidocaine spray.
注射局部麻醉剂是儿童出现回避行为的最重要原因之一。在注射前应用局部麻醉剂是控制疼痛最常用的方法；然而，局部麻醉剂存在一些缺点，如作用时间较长、味道不佳以及麻醉剂扩散到非注射部位区域。使用制冷剂进行冷冻麻醉作为局部麻醉的一种替代方法正在被研究，以克服局部麻醉剂的缺点，并已显示出有前景的结果。
在这项双盲设计研究中，选取了50名年龄在8至10岁、需要双侧下颌局部麻醉的儿童。在第一次就诊时，在一侧使用局部麻醉喷雾剂（利多卡因），在第二次就诊时，在另一侧局部麻醉给药前使用冷冻麻醉剂四氟乙烷。要求患者使用视觉模拟量表（VAS）（主观方法）报告他们的不适和疼痛。由牙医通过声音、眼睛和运动（SEM）量表评估患者注射期间的疼痛感知（客观方法）。
使用配对威尔科克森符号秩检验和曼 - 惠特尼检验对结果进行统计学分析。在VAS量表（主观方法）中，与利多卡因组相比，四氟乙烷组的疼痛评分显著更低。在SEM量表（客观方法）中，与利多卡因组相比，四氟乙烷组的疼痛评分更低，但差异无统计学意义。
与局部麻醉剂利多卡因喷雾剂相比，使用制冷剂四氟乙烷喷雾剂对注射部位进行预冷已显示出在消除儿童局部麻醉给药前的疼痛方面是有效的。
