在下颌第三磨牙拔除术中，预充式骨内麻醉作为下牙槽神经阻滞麻醉的替代方法：一项随机临床试验。

Programmed-release intraosseus anesthesia as an alternative to lower alveolar nerve block in lower third molar extraction: a randomized clinical trial.

作者信息

Pol Renato, Ruggiero Tiziana, Bezzi Marta, Camisassa Davide, Carossa Stefano

机构信息

Oral Surgery Unit, Dentistry Section, Department of Surgical Sciences, University of Turin, Dental School, Turin, Italy.

出版信息

J Dent Anesth Pain Med. 2022 Jun;22(3):217-226. doi: 10.17245/jdapm.2022.22.3.217. Epub 2022 May 27.

DOI:10.17245/jdapm.2022.22.3.217

PMID:35693356

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9171337/

Abstract

BACKGROUND

Intraosseous anesthesia is the process by which an anesthetic solution, after penetration of the cortical bone, is directly injected into the spongiosa of the alveolar bone supporting the tooth. This study aimed to compare the effectiveness of the traditional inferior alveolar nerve block (IANB) and computerized intraosseous anesthesia in the surgical extraction of impacted lower third molars, compare their side effects systemically by monitoring heart rate, and assess patients' a posteriori preference of one technique over the other.

METHODS

Thirty-nine patients with bilaterally impacted third molars participated in this study. Each patient in the sample was both a case and control, where the conventional technique was randomly assigned to one side (group 1) and the alternative method to the contralateral side (group 2).

RESULTS

The traditional technique was faster in execution than anesthesia delivered via electronic syringe, which took 3 min to be administered. However, it was necessary to wait for an average of 6 ± 4 min from the execution to achieve the onset of IANB, while the latency of intraosseous anesthesia was zero. Vincent's sign and lingual nerve anesthesia occurred in 100% of cases in group 1. In group 2, Vincent's sign was recorded in 13% of cases and lingual anesthesia in four cases. The average duration of the perceived anesthetic effect was 192 ± 68 min in group 1 and 127 ± 75 min in group 2 (P < 0.001). The difference between the heart rate of group 1 and group 2 was statistically significant. During infiltration in group 1, heartbeat frequency increased by 5 ± 13 beats per minute, while in group 2, it increased by 22 ± 10 beats per minute (P < 0.001). No postoperative complications were reported for either technique. Patients showed a preference of 67% for the alternative technique and 20% for the traditional, and 13% of patients were indifferent.

CONCLUSION

The results identified intraosseous anesthesia as a valid alternative to conventional anesthesia in impacted lower third molar extraction.

摘要

背景

骨内麻醉是指麻醉溶液穿透皮质骨后，直接注入支持牙齿的牙槽骨松质内的过程。本研究旨在比较传统下牙槽神经阻滞（IANB）和计算机化骨内麻醉在拔除下颌阻生第三磨牙手术中的有效性，通过监测心率系统比较它们的副作用，并评估患者对两种技术的事后偏好。

方法

39例双侧下颌阻生第三磨牙患者参与本研究。样本中的每位患者既是病例又是对照，其中传统技术随机分配至一侧（第1组），另一种方法分配至对侧（第2组）。

结果

传统技术的操作速度比通过电子注射器给药的麻醉更快，后者给药需要3分钟。然而，从操作到IANB起效平均需要等待6±4分钟，而骨内麻醉的潜伏期为零。第1组100%的病例出现了翼下颌皱襞征和舌神经麻醉。在第2组中，13%的病例记录到翼下颌皱襞征，4例出现舌部麻醉。第1组感觉麻醉效果的平均持续时间为192±68分钟，第2组为127±75分钟（P<0.001）。第1组和第2组的心率差异具有统计学意义。在第1组浸润过程中，心跳频率每分钟增加5±13次，而在第2组中，每分钟增加22±10次（P<0.001）。两种技术均未报告术后并发症。患者对另一种技术的偏好为67%，对传统技术的偏好为20%，13%的患者无差异。