Bhargava Darpan, Ahirwal Rajkumar, Koneru Ganesh, Srikanth Balaji R, Beena Sivakumar
Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences, People's University, Bhopal, M.P, 462037, India.
Department of Anesthesia & Critical Care, Gandhi Medical College and Associated Hospitals, Bhopal, M.P, India.
Oral Maxillofac Surg. 2018 Dec;22(4):457-461. doi: 10.1007/s10006-018-0733-7. Epub 2018 Oct 16.
To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase.
A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations.
Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix).
Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)-(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS).
The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41 ± 48.67 ng/ml and for IS group it was 209.67 ± 88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P = 0.605).
Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.
确定翼下颌间隙注射地塞米松并与下牙槽神经阻滞联合使用后所达到的地塞米松血浆浓度，以及与术后临床效果的相关性。
一项初步前瞻性研究，评估在翼下颌间隙注射地塞米松与2%利多卡因下牙槽神经阻滞联合使用以实现半侧下颌麻醉用于小型口腔外科手术时所达到的地塞米松血浆浓度，并得出临床相关性。
地塞米松是一种糖皮质激素，主要用于治疗颌面外科手术中诸如牙关紧闭和肿胀等术后后遗症。传统上，肠外地塞米松通过静脉或肌肉途径给药。翼下颌间隙注射是文献中描述的一种新型类固醇给药途径。对于颌面外科手术中需要下牙槽神经阻滞的小型口腔外科手术，地塞米松可与局部麻醉剂通过单次注射作为混合物（双混液）一起给药。
设计前瞻性双盲随机临床试验，以评估在翼下颌间隙注射1.8毫升含肾上腺素（1:200000）的2%利多卡因与1毫升（4毫克）地塞米松的新鲜制备混合物[2.8毫升双混液]后所达到的地塞米松血浆浓度。纳入试验的30名受试者被随机分为三个研究组（每组10名）：（1）对照组（C）；（2）肌肉注射组（IM）；（3）间隙内注射组（IS）。
注射后30分钟，IM组的平均血浆地塞米松浓度为226.41±48.67纳克/毫升，IS组为209.67±88.13纳克/毫升。对血浆地塞米松浓度（IM组和IS组）进行事后（Bonferroni-Holm检验）组间比较，发现无统计学意义（P = 0.605）。
在需要局部麻醉进行下颌小型口腔手术的患者中，间隙内给药途径可用于安全地递送地塞米松化局部麻醉剂，并产生可预测的临床效果。
