Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Meenakshi Academy of Higher Education and Research, Tamilnadu, Chennai.
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Tamil Nadu, India.
Eur Endod J. 2020 Dec;5(3):191-198. doi: 10.14744/eej.2020.38358.
The purpose of this randomized trial was to assess the pain perception during intrapulpal anesthesia (IP) using thinner gauge needles and syringes with or without topical anaesthesia as an adjunct.
One hundred patients, on whom the inferior alveolar nerve block and intraligamentary injections failed, were recruited for the trial. Block randomization was performed and the patients were allocated into 4 groups based on the needle gauge and topical application of anaesthesia prior to IP injection. In two groups (27GN, 31GN) the patients received IP injection with 27 gauge or 31 gauge needles. The patients of other two groups received topical lignocaine-prilocaine mixture prior to the IP injection with 27 or 31 gauge needles, respectively (27GT, 31GT). The visual analogue scale (VAS) was used to assess the pain immediately after IP injection and after cleaning and shaping by a blinded outcome assessor. The Kruskal-Wallis test for overall comparisons followed by the post-hoc analysis using the Conover's test (P<0.05) was done. Chi-square and Fischer exact test was used to assess the proportion of patients who were comfortable during IP anaesthesia.
The intensity of pain during IP administration with 31GN and 31GT (3.7 and 2.3 respectively) was significantly less in comparison to 27GN and 27GT (5.6 and 5.7 respectively). The proportion of patients who were significantly comfortable with IP injections in the groups 31GN and 31GT (52% and 80% respectively) were more (VAS<4) when compared to 27GN and 27GT (12% and 8% respectively). Topical application of lignocaine-prilocaine reduced the pain on IP injection significantly when used as an adjunct with 31 gauge needles. The anaesthetic success of IP anaesthesia was comparable and 100% (VAS scoring <4) in all the groups.
Thinner gauge needles (31 gauge) significantly reduce pain perceived during IP anaesthesia. Topical anaesthesia with lignocaine-prilocaine acts as an effective adjunct only with 31gauge needle.
本随机试验的目的是评估在使用更细的针和注射器进行牙髓内麻醉（IP）时的疼痛感知，同时将局部麻醉作为辅助手段。
本试验招募了 100 名在下颌神经阻滞和牙周韧带内注射失败的患者。采用随机分组，根据针的规格和 IP 注射前局部应用麻醉剂，将患者分为 4 组。在两组（27GN、31GN）中，患者分别接受 27 号和 31 号针进行 IP 注射。另外两组（27GT、31GT）的患者在接受 27 号或 31 号针进行 IP 注射前，分别接受局部利多卡因-丙胺卡因混合物（lignocaine-prilocaine mixture）处理。使用视觉模拟评分法（VAS）评估 IP 注射后即刻以及盲法评估人员清洁和塑形后的疼痛。采用 Kruskal-Wallis 检验进行总体比较，然后使用 Conover 检验进行事后分析（P<0.05）。采用卡方检验和 Fisher 确切概率法评估在 IP 麻醉期间感到舒适的患者比例。
使用 31GN 和 31GT 进行 IP 给药时的疼痛强度（分别为 3.7 和 2.3）明显低于使用 27GN 和 27GT 时的疼痛强度（分别为 5.6 和 5.7）。在 31GN 和 31GT 组中，明显感到 IP 注射舒适的患者比例（分别为 52%和 80%）明显更高（VAS<4），而在 27GN 和 27GT 组中，感到舒适的患者比例（分别为 12%和 8%）明显更低。局部应用利多卡因-丙胺卡因显著减轻了与 31 号针联合使用时的 IP 注射疼痛。所有组的 IP 麻醉的麻醉效果相当，均为 100%（VAS 评分<4）。
更细的针（31 号）可显著减轻 IP 麻醉期间的疼痛感知。局部麻醉剂利多卡因-丙胺卡因仅与 31 号针联合使用时才是有效的辅助手段。
