Moaddabi Amirhossein, Valletta Alessandra, Koochek Dezfuli Mohammad, Soltani Parisa, Ebrahimikiyasari Saeedeh, Hosseinnataj Abolfazl, Tafti Kioumars Tavakoli, Spagnuolo Gianrico
Department of Oral and Maxillofacial Surgery, Dental Research Center, School of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
Int J Dent. 2023 Mar 17;2023:5922663. doi: 10.1155/2023/5922663. eCollection 2023.
The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques.
In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20-60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov-Smirnov test, Mann-Whitney test, independent -test, and Fisher's exact test were performed for statistical analysis ( = 0.05).
This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques.
Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients' vital signs significantly. This trial is registered with IRCT20220106053646N1.
控制疼痛的能力是牙科手术的重要组成部分，实现最佳疼痛控制和减轻不适感是每位牙医的首要关注点。本研究旨在比较传统两步注射技术与新改良两步注射技术在下牙槽神经阻滞过程中的疼痛情况和生命体征。
在这项机构单盲随机临床试验中，纳入了2022年2月至5月马赞德兰医科大学牙科学院的参与者。纳入标准为年龄在20至60岁之间且健康（ASA1级）、愿意参与本研究的个体。排除正在服用影响其疼痛认知的药物的个体以及注射部位有活动性感染的患者。这些个体被分为两组。首先进行表面麻醉，然后分别采用传统注射技术和两步注射技术。对于两步注射法，将6毫米的针头刺入黏膜，通过计算机控制的注射工具包注入三分之一的局部麻醉溶液。之后，将一根25毫米的30号针头重新插入先前的孔中，注入剩余的局部麻醉剂。注射过程中的疼痛通过患者报告的数字评分量表（NRS）进行测量。此外，在注射前后立即监测生命体征。采用Kolmogorov-Smirnov检验、Mann-Whitney检验、独立t检验和Fisher精确检验进行统计分析（α = 0.05）。
本研究纳入了32名年龄在20至50岁之间的成年人，男女比例为1∶1。在所有性别和年龄组中，传统注射技术的疼痛评分显著高于两步注射技术。传统注射技术和两步注射技术在生命体征方面无显著差异。无论采用何种注射技术，女性和男性的平均疼痛评分均无显著差异。
在下牙槽阻滞患者中采用两步注射技术可减轻注射时的疼痛，且不会显著改变患者的生命体征。本试验已在伊朗临床试验注册中心注册（注册号：IRCT20220106053646N1）。
