Krishna Sai, Selvarasu Kathiravan, Kumar Santhosh P, Krishnan Murugesan
Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Cureus. 2024 Jan 31;16(1):e53277. doi: 10.7759/cureus.53277. eCollection 2024 Jan.
Background The inferior alveolar nerve block (IANB) is a commonly employed technique in oral surgery for achieving profound anesthesia in the mandibular teeth and associated structures. Several techniques have been developed to enhance the success rate and patient comfort during the IANB. The aim of this study was to compare and evaluate the efficacy of different IANB techniques for mandibular anesthesia. Materials and methods The participants included in the study were adults requiring surgical extraction of an impacted mandibular third molar teeth. A total of 100 participants were randomly assigned to five different groups representing various techniques of IANB, i.e., conventional Halsted technique, Vazirani-Akinosi technique, Gow-Gates technique, Fischer 1-2-3, and extraoral Kurt-Thoma technique, with 20 participants in each group. The participants were evaluated for the onset of anesthesia using subjective and objective methods, pain perception during the administration of local anesthesia using a 10-point visual analogue scale (VAS), and the incidence of trismus postoperatively. Data were analyzed using IBM SPSS Statistics for windows, version 23.0 (released 2015; IBM Corp Armonk, United States) with p-values less than 0.05 considered as statistically significant. Descriptive statistics, Kruskal-Wallis, and post-hoc tests were included in the data analysis for intergroup comparisons. Results The primary outcomes evaluated were the onset of anesthesia, the patient's perception of pain during the administration of local anesthesia, and the secondary outcome included in the incidence of trismus. In this study, it was found that the Kurt-Thoma technique had the fastest onset of anesthesia (2.25 minutes), higher incidence of trismus (25%), and higher pain perception (6.5 score on VAS). The conventional Halstead technique (3.55 minutes), Fischer 1-2-3 technique (3.5 minutes), and Vazirani-Akinosi technique (3.1 minutes) had an almost similar mean duration of anesthesia. The onset of anesthesia was delayed in the Gow-Gates technique (5.1 minutes). Patient perception of pain during administration of local anesthesia was higher in the Kurt-Thoma (6.5) and Gow-Gates techniques (4.95), and it was least in the Fischer 1-2-3 technique (0.75) in the VAS scores. The incidence of trismus was highest with the Kurt-Thoma technique (25%), then the Gow-Gates technique (20%), followed by the conventional Halstead technique (5%). Conclusion In this study, it was found that the conventional Halsted technique was the best among the different techniques of IANB and remains the gold standard.
下牙槽神经阻滞（IANB）是口腔外科中常用的技术，用于使下颌牙齿及相关结构获得深度麻醉。已经开发了几种技术来提高IANB期间的成功率和患者舒适度。本研究的目的是比较和评估不同IANB技术在下颌麻醉中的疗效。
纳入研究的参与者为需要外科拔除下颌阻生第三磨牙的成年人。总共100名参与者被随机分配到代表IANB不同技术的五个不同组，即传统的霍尔斯特德技术、瓦齐拉尼 - 阿基诺西技术、戈 - 盖茨技术、菲舍尔1 - 2 - 3技术和口外库尔特 - 托马技术，每组20名参与者。使用主观和客观方法评估参与者的麻醉起效情况，使用10分视觉模拟量表（VAS）评估局部麻醉给药期间的疼痛感知，以及术后牙关紧闭的发生率。使用IBM SPSS Statistics for windows，版本23.0（2015年发布；IBM公司，美国阿蒙克）进行数据分析，p值小于0.05被认为具有统计学意义。描述性统计、克鲁斯卡尔 - 沃利斯检验和事后检验包括在数据分析中用于组间比较。
评估的主要结果是麻醉起效、患者在局部麻醉给药期间的疼痛感知，次要结果包括牙关紧闭的发生率。在本研究中，发现库尔特 - 托马技术的麻醉起效最快（2.25分钟），牙关紧闭发生率较高（25%），疼痛感知较高（VAS评分为6.5分）。传统的霍尔斯特德技术（3.55分钟）、菲舍尔1 - 2 - 3技术（3.5分钟）和瓦齐拉尼 - 阿基诺西技术（3.1分钟）的平均麻醉持续时间几乎相似。戈 - 盖茨技术的麻醉起效延迟（5.1分钟）。在VAS评分中，库尔特 - 托马技术（6.5）和戈 - 盖茨技术（4.95）在局部麻醉给药期间患者的疼痛感知较高，而菲舍尔1 - 2 - 3技术（0.75）最低。牙关紧闭发生率最高的是库尔特 - 托马技术（25%），其次是戈 - 盖茨技术（20%），然后是传统的霍尔斯特德技术（5%）。
在本研究中，发现传统的霍尔斯特德技术在不同的IANB技术中是最好的，仍然是金标准。
