Esteve-Pardo G, De-Larriva E, Salgado A, Bernabeu-Esclapez A, Bardaji J A, Esteve-Colomina L
Private Practice, Master Degree in Biotechnology and Bioengineering in Bioengineering Institute, Miguel Hernández University of Elche, Spain.
Private practice at Madrid, Spain.
J Oral Maxillofac Surg. 2022 Mar;80(3):490-500. doi: 10.1016/j.joms.2021.09.028. Epub 2021 Oct 10.
There is no agreement in the literature on whether inferior alveolar nerve block (IANB) or infiltration (INF) is the anesthetic technique of choice for placing implants in the posterior mandible. This study aimed to compare the efficacy of the 2 techniques using articaine 4% with epinephrine 1:100,000.
The trial was a comparison between 2 parallel groups of patients, who received implants distal to the mental foramen, either with IANB or INF. The anesthetic technique was the predictor variable. The primary outcome was patients' perceived pain by a numerical rating scale (NRS) in incision, osteotomy and suture. The secondary outcome, patients' satisfaction, was equally recorded 12 hours after surgery. The dataset were first analyzed by descriptive statistics. Then, Mann-Whitney test, Spearman's coefficient, and regression models were used. This trial followed the recommendations of the Consort Statement for reporting randomized controlled trials (RCTs).
Ninety-six patients (41 men, 55 women, mean age 55.76 years) were randomly assigned to either group, IANB or INF, of 48 patients each. Only 20% of patients reported pain values >0 (range 0-4 of 10). Medians were: 0 (0-0) for both groups (P = .956, .175 and .908, incision, osteotomy and suture, respectively). Mean satisfaction was high in both groups, 9.0 ± 1.0, median 10; and 8.8 ± 1.7, median 9, for IANB and INF (P = .695). Hence, the anesthetic technique did not generate statistically significant differences. Five potential influencing variables that were measured did not significantly affect pain levels or patient satisfaction in either group.
According to the results, an IANB might not be necessary for standard implant surgery in the posterior mandible, and infiltration of articaine 4% with epinephrine 1:100,000 appears to be sufficient. Further research is needed to check if these results are extensible to other anesthetic drugs.
关于在下颌骨后部植入种植体时，下牙槽神经阻滞（IANB）或浸润麻醉（INF）哪种麻醉技术是首选，文献中尚无定论。本研究旨在比较使用4%阿替卡因加1:100,000肾上腺素的这两种技术的疗效。
该试验为两组平行患者的比较，这些患者在颏孔远端接受种植体植入，分别采用IANB或INF。麻醉技术为预测变量。主要结局是患者在切口、截骨和缝合时通过数字评分量表（NRS）感知的疼痛。次要结局，即患者满意度，在术后12小时同样进行记录。数据集首先通过描述性统计进行分析。然后，使用曼-惠特尼检验、斯皮尔曼系数和回归模型。本试验遵循了CONSORT声明中关于报告随机对照试验（RCT）的建议。
96例患者（41例男性，55例女性，平均年龄55.76岁）被随机分为两组，IANB组和INF组各48例。仅20%的患者报告疼痛值>0（范围为0至10分中的0至4分）。两组的中位数分别为：切口、截骨和缝合时均为0（0至0）（P分别为0.956、0.175和0.908）。两组的平均满意度都较高，IANB组为9.0±1.0，中位数为10；INF组为8.8±1.7，中位数为9（P=0.695）。因此，麻醉技术未产生统计学上的显著差异。所测量的五个潜在影响变量在两组中均未显著影响疼痛程度或患者满意度。
根据结果，在下颌骨后部进行标准种植手术时可能无需进行IANB，4%阿替卡因加1:100,000肾上腺素的浸润麻醉似乎就足够了。需要进一步研究以检查这些结果是否可推广到其他麻醉药物。
