Haas D A, Lennon D
Department of Anesthesia, Faculty of Dentistry, University of Toronto, ON.
J Can Dent Assoc. 1995 Apr;61(4):319-20, 323-6, 329-30.
A retrospective study of paresthesia following the injection of local anesthetic in dentistry was conducted by examining every report of paresthesia recorded by Ontario's Professional Liability Program from 1973 to 1993, inclusive. Only those cases where surgery was not conducted were considered in this study. The parameters examined included patient age and gender, needle gauge, site of injection, area affected, report of pain or any additional symptoms, and the type of local anesthetic used. From 1973 to 1993, there were 143 reports of paresthesia not associated with surgery. There were no significant differences found with respect to patient age, patient gender, or needle gauge. All reports involved anesthesia of the mandibular arch, with the tongue most frequently reported to be symptomatic, followed by the lip. Pain was reported in 22 per cent of the cases. Paresthesia was reported most often following the injection of articaine and prilocaine. In 1993 alone, there were 14 reports of paresthesia not associated with surgery. This can be projected to an incidence of 1:785,000 injections. Articaine was administered in 10 of these cases or prilocaine in the other four. The observed frequencies of paresthesia following the administration of articaine (p < 0.002) or prilocaine (p < 0.025) were significantly greater than the expected frequencies for these agents, based on the distribution of local anesthetic use in Ontario in 1993. These results are consistent with the suggestion that local anesthetic formulations may have the potential for mild neurotoxicity. Further studies are needed to investigate the mechanisms for this, and to determine whether similar findings would be found elsewhere.
通过查阅安大略省职业责任计划记录的1973年至1993年（含）期间每一份感觉异常报告，对牙科局部麻醉注射后感觉异常进行了一项回顾性研究。本研究仅考虑未进行手术的病例。所检查的参数包括患者年龄和性别、针规、注射部位、受影响区域、疼痛或任何其他症状报告以及所用局部麻醉剂的类型。1973年至1993年，有143份与手术无关的感觉异常报告。在患者年龄、患者性别或针规方面未发现显著差异。所有报告均涉及下颌弓麻醉，最常报告有症状的是舌头，其次是嘴唇。22%的病例报告有疼痛。感觉异常最常发生在注射阿替卡因和丙胺卡因之后。仅在1993年，就有14份与手术无关的感觉异常报告。据此推算，发生率为每785,000次注射中有1例。其中10例使用了阿替卡因，另外4例使用了丙胺卡因。基于1993年安大略省局部麻醉剂的使用分布，注射阿替卡因（p < 0.002）或丙胺卡因（p < 0.025）后观察到的感觉异常频率显著高于这些药物的预期频率。这些结果与局部麻醉剂配方可能具有轻度神经毒性的观点一致。需要进一步研究来调查其机制，并确定其他地方是否也会有类似发现。
