State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
PeerJ. 2023 Jun 29;11:e15585. doi: 10.7717/peerj.15585. eCollection 2023.
Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients.
An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment.
Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied.
Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.
安全有效的局部麻醉是急诊口腔手术和大多数牙科治疗的前提。妊娠的特点是复杂的生理变化和对疼痛的敏感性增加。孕妇特别容易患上口腔疾病，如龋齿、牙龈炎、化脓性肉芽肿和第三磨牙冠周炎。母体给予的药物可以通过胎盘影响胎儿。因此，许多医生和患者都不愿意提供或接受必要的局部麻醉，这导致病情延误和不良后果。本综述旨在全面讨论孕妇口腔治疗局部麻醉的指南。
深入检索 Medline、Embase 和 Cochrane 图书馆，查阅有关母体和胎儿生理学、局部麻醉药理学及其在口腔治疗中的应用的文章。
标准口腔局部麻醉在整个孕期是安全的。目前，2%利多卡因加 1:200,000 肾上腺素被认为是平衡孕妇安全性和疗效的最佳麻醉剂。必须考虑母体和胎儿的因素，以适应妊娠期的生理和药理学变化。对于高危产妇，建议采取半仰卧位、血压监测和安慰，以降低血压、缺氧和低血糖短暂变化的风险。对于患有子痫前期、高血压、低血压和妊娠期糖尿病等基础疾病的患者，医生应谨慎使用肾上腺素，并控制麻醉剂的剂量。新的局部麻醉配方和设备有助于最大限度地减少注射疼痛和缓解焦虑，已经并正在开发中，但研究仍不足。
了解妊娠期间的生理和药理学变化对于确保局部麻醉的安全性和效率至关重要。母亲和胎儿的最佳结果取决于对生理变化的深入了解，以及对麻醉药物和方法的适当选择。
