local anesthesia

We aimed to compare the effect of 0.75% ropivacaine and 2% lidocaine with 1:100,000 epinephrine on intraoperative bleeding and postoperative pain following mandibular third molar surgery.

In this split-mouth clinical trial, 60 patients required bilateral impacted third molar of the mandible were prepared for operation in the Department of Maxillofacial Surgery of Mashhad Dental Faculty, Mashhad, Iran. Surgery was performed randomly on one side using ropivacaine and on the other side with lidocaine with epinephrine. The intraoperative bleeding, the postoperative pain (at 3, 6, 12, 18, and 24 hours after the operation), and the difficulty of the surgery were measured in each group and compared.

In all postoperative time intervals, the pain was lower in the ropivacaine group than in the lidocaine group. The rate of intraoperative bleeding in the ropivacaine group was lower than in the lidocaine group. In the lidocaine group, pain initially increased and reached its maximum value after three hours, but decreased after the sixth hour and reached its minimum value 24 hours after surgery. In the ropivacaine group, the pain increased initially and was at its peak at 3 and 6 hours, after which it decreased and reached its lowest value at 24 hours.

Postoperative pain was less in the 0.75% ropivacaine group than in the 2% lidocaine with 1:100,000 epinephrine group during all postoperative periods. Also, the amount of bleeding during the operation was less in the ropivacaine group.

Dental students and interns have experienced inferior alveolar nerve block (IANB) failures in their clinical practice Method The current study was designed to assess the performance of senior dental students in the injection of IANB.

This analytic cross-sectional study included 23 senior dentistry students. The dental students were included if they were willing to participate in this study and 115 patients requiring inferior alveolar nerve block injection referred to the oral and maxillofacial department of the university were enrolled in this study. The demographic data of the students and patients were recorded. After the IANB injection, pain at the entrance of the needle, the subjective onset of the injection, and the success of the injection were recorded. The data was analyzed by SPSS version 26. The independent t-test and chi-square were applied at the significance level of 0.05.

The patients significantly reported “no pain” more frequently than “painful” when the needle entered the mucosa (P=0.038). The “good onset” was significantly reported more often than “acceptable onset” and “failed onset” (P=0.012, and P=0.001, respectively). The “acceptable onset” was more frequently recorded than the “failed onset”. (P=0.049) The “successful” IANB injection was significantly more frequent than “failure. (P=0.023) Gender and age of students had no significant relation with the overall success of IANB injection. (P=0.683, and P=0.549, respectively) Gender and age of patients also had no significant relation with the overall success of IANB injection. (P=0.889, and P=0.896, respectively)

The senior dental students were mainly successful in the IANB injection.

Paresthesia is described as a burning or prickling sensation or partial numbness caused by neurologic injury. The sensory loss may be the result of a reversible and/or irreversible nerve damage, and it can be caused by local or systemic factors. Local factors include traumatic injuries caused by impacted teeth, local injection, endodontic therapy, implant placement and exposure to toxic materials. This article reports a paresthesia by anesthetic injection. A 44-year-old man reported moderate pain during chewing and exposure to cold. Upon clinical examination, extension of the tooth fracture line was in the mesiodistal region of the mandibular left second premolar crown and was detected with 16× magnification of microscope. The diagnosis was cracked tooth syndrome, and root canal treatment was indicated. After the first appointment the patient reported altered sensation on left side of mandible, numbness and electric shock sensation, and therefore was diagnosed with mental nerve paresthesia. Diclofenac sodium, thiamine, cyanocobalamin, and pyridoxine were prescribed for 7 days as part of the treatment, and then root canal and restorative treatments were completed. Patient was scheduled for follow-up appointments after 1, 3, 6, and 8 months. After the first month, the feeling of paresthesia was still present and the patient was experiencing a painful “electric shock”. At the 8-month follow-up visit, the paresthesia had been resolved with return of normal sensation.

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P<0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications.

Prostate cancer is one of the most common cancers in men. This study investigates the effectiveness of oral pregabalin combined with local anesthesia in reducing pain for patients undergoing prostate biopsy.

In this randomized clinical trial, 78 patients candidates for prostate biopsy were divided into two groups: the control group (local anesthesia with lidocaine) and the intervention group (100 mg oral pregabalin two hours before the procedure + local anesthesia). The biopsy was performed under rectal ultrasound guidance. Patients’ pain intensity was evaluated one and six hours post-biopsy using the Visual Analogue Scale (VAS).

The most common reason for referral in both groups was Lower Urinary Tract Symptoms (LUTS) (48.7% in the control group and 41% in the intervention group). Pain intensity was significantly lower in the intervention group compared to the control group (p<0.001). This difference was observed both at one hour and six hours post-procedure. Cigarette smoking had no significant effect on pain levels.

Administration of 100 mg oral pregabalin two hours before prostate biopsy, combined with local anesthesia, results in a significant reduction in patient pain during the hours following the procedure. This finding could help improve patient experience and increase their acceptance of undergoing prostate biopsy.

Superior vena cava (SVC) syndrome is a set of clinical indications and symptoms that occur due to the partial or complete blockage of blood flow through this vein. This rare complication, which leads to vein occlusion, will be more complicated if there is a mediastinal mass. Although the incidence of SVC syndrome has decreased significantly in recent years, the anesthetic management of such patients remains challenging due to life-threatening side effects, such as airway obstruction and cardiovascular collapse. We report the successful management of a 56-year-old woman with a history of hemodialysis who was a candidate for cardiac pulmonary bypass and clot removal under local and general anesthesia. 

 The application of local anesthesia in dental surgeries conducted under general anesthesia poses a challenge in pediatric dentistry. There is a lack of consensus regarding the benefits and drawbacks of using general anesthesia in this field.

 The purpose of this study was to assess the attitudes and practices of pediatric dentists regarding the use of local anesthesia for dental treatments in children under general anesthesia in Iran.

 This cross-sectional study involved 110 pediatric dentists from across Iran. The dentists' professional attitudes and practices were assessed using a specially designed questionnaire for this study. The questionnaire was distributed through the Line press system, and the data were analyzed following collection.

 Regarding professional practices, 34.5% of specialists refrained from using local anesthesia. The most frequent application of local anesthesia was observed in tooth extractions. The preferred local anesthetic agent was 2% lidocaine with 1:100 000 epinephrine. A lower dose than that used in outpatient settings was administered, and most specialists allowed sufficient time for the anesthesia to take effect.

 This study revealed that opinions and attitudes towards the use of local anesthesia in the dental treatment of children under general anesthesia vary across different specialties and are significantly influenced by the patient's condition, type of treatment, and practice techniques.

A seven-year-old girl was referred for the treatment of her primary teeth. An inferior alveolar nerve block was administered using 1 mL of 2% lidocaine. Shortly after the injection, the patient experienced pain, erythema, blurred vision, and temporary loss of vision in her right eye. Based on these symptoms, a diagnosis of transient vision loss due to the anesthetic injection was made. The situation was explained to the child and her parents, assuring them that the complication was temporary. The right eye was covered with wet gauze, and all symptoms resolved within 20 minutes. A follow-up ophthalmological examination showed no abnormalities, and the procedure was successfully completed without further complications. A one-day follow-up revealed no issues.

Although most of the metabolism of local anesthetics (LAs) takes place in the liver, no study has investigated the effect of these anesthetics on the kidney function of single‑kidney humans or animals. The present study was conducted to examine the effect of LAs on renal function in single‑kidney rats.

The present experimental animal study with two control groups was done in an animal laboratory. Forty‑two rats were randomly assigned to seven groups of six rats, including two control groups and five experimental groups. The experimental groups underwent intraperitoneal anesthesia with 2% lidocaine, 2% lidocaine with 1:80,000 epinephrine, 4% articaine, 3% prilocaine with 0.03 IU Felypressin, and 3% mepivacaine, respectively. Unilateral nephrectomy was done. After 24 h, the rats’ blood urea nitrogen (BUN), serum creatinine (Cr), and blood specific gravity (BSG) were measured. A standard dose of anesthetics was injected into the peritoneum for 4 days afterward. Then, these indices were measured again 24 h after the last injection. Data were analyzed using IBM SPSS (version 21.0). One‑way analysis of variance, Tukey’s honestly significant difference post hoc, and paired t‑tests were used for statistical analysis. P < 0.05 was considered statistically significant.

The results indicated significant differences among groups in the rats’ BUN and serum Cr 24 h after nephrectomy (P < 0.05). However, there were no significant differences in BUN, BSG, and Cr among groups after the interventions.

LAs did not affect renal function in single‑kidney rats. Therefore, dentists can use the anesthetics in single‑kidney people.

This study investigated the photobiomodulation effect of an 810-nm diode laser in adjunction with topical anesthesia on pain perception during infiltration anesthesia of primary maxillary molars in children.

This double-blind randomized controlled clinical trial was conducted on 64 children (aged 5-9 years) requiring extraction or stainless steel crown for their primary maxillary molars. The patients were randomly allocated into two groups (n = 32) of laser and control. In the laser group, the injection site (buccal and palatal mucosa) was irradiated with an 810-nm laser (200 mW, 5.2 J/cm2) after 20% benzocaine topical anesthetic application, while the control group received a placebo laser following topical anesthesia. The pain intensity experienced by children during needle insertion into the buccal and palatal mucosa was determined using a visual analog scale (VAS) and modified behavioral pain scale (MBPS).

According to the results of the VAS and MBPS, no significant difference was detected in pain scores between the laser and control groups neither in the buccal nor in the palatal mucosa (P > 0.05).

Photobiomodulation therapy with an 810-nm laser with the current setting adjunct to topical anesthesia did not promote significant additional effects on the pain intensity.

Several adjuvants, added to local anesthetics, were suggested to induce an ideal regional block with high-quality analgesia. The purpose of this study was to evaluate the particular blocking properties of low-dose bupivacaine in combination with meperidine and fentanyl in spinal anesthesia during Cesarean sections. A randomized, double-blind clinical trial was conducted at Hafez Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from February 2015 to February 2016. A total of 120 pregnant women, who underwent spinal anesthesia during elective Cesarean section were enrolled in the study. Based on block-wise randomization, the patients were randomly assigned to three groups, namely “B” group received 2 mL bupivacaine 0.5% (10 mg), “BM” group received 8 mg bupivacaine and 10 mg meperidine, and “BF” group received 8 mg bupivacaine and 15 µg fentanyl intrathecally. The block onset, the duration of analgesia, and the time of discharge from the post-anesthesia care unit (PACU) were all assessed. Data were analyzed using SPSS software version 21, and P<0.05 were considered statistically significant. The mean duration of motor blocks in the B group (150 min) were significantly higher than the BM (102 min) and BF (105 min) groups (P<0.0001). In both the BM and BF groups, the duration of sensory and motor blocks was the same. The length of stay in the PACU was significantly longer in the B group (P<0.001) than the BM and BF groups. When meperidine or fentanyl was added to bupivacaine, the duration of the analgesia lengthened (P<0.001).  Intrathecal low-dose spinal anesthesia induced by bupivacaine (8 mg) in combination with meperidine and/or fentanyl for Cesarean section increased maternal hemodynamic stability, while ensuring effective anesthetic conditions, extending effective analgesia, and reducing the length of stay in PACU.Trial Registration Number: IRCT2015013119470N14.

Obtaining a blood-free surgical field is critical during carpal tunnel decompression (CTD) to identify anatomic structures and avoid iatrogenic injury. A tourniquet is often used to minimize bleeding and improve visualization. However, it may be associated with discomfort and intolerance when sedation is not employed. WALANT ("Wide awake local anesthesia no tourniquet") technique surgeries have become very popular and enable the patient to be involved in the procedure; in addition, the adrenaline avoids the use of the tourniquet and the discomfort it produces. We hypothesized that there is no difference in postoperative pain after CTD between local anesthetic with a tourniquet (LA-T) and WALANT technique. The objective of this paper is to report the results of CTD, comparing those performed with local anesthesia and those performed with the WALANT. In this prospective study, 60 CTS were operated in two different institutions. Patients in group 1 (30 patients) were operated under LA-T, while patients in group 2 (30patients) were operated on using lidocaine with epinephrine (WALANT). Statistical analysis was performed. Postoperative pain immediately after surgery, at 4 and 24 hours, and 15, and 30 days after surgery; and degree of satisfaction did not show a significant difference between the two groups. Moreover, surgical time was slightly shorter in the LA-T group, but the difference was not significant. In our study, CTD performed with LA-T, and WALANT technique resulted in similar results. In cases of experienced surgeons, LA-T may be enough to perform the procedure, avoiding epinephrine's low but complex complications. In less experienced surgeons who require more surgical time, the use of WALANT may increase the intraoperative comfort of the patient.  Level of evidence: IV

Infants and children who experience pain in early life, show long‑term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety‑provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children’s dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6–8‑year‑old children.

In this randomized, clinical, in vivo study with a split‑mouth design we compared the pain of 30 children (6–8‑year‑old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong‑Baker faces pain scale (FPS) and FPS‑Revised. The Chi‑square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance.

Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction.

Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

One of the most important objectives of pediatric dentistry during dental practice is pain control and effective anesthesia. Because of the limitations of inferior alveolar nerve block (IANB),other techniques such as infiltration injection are suggested.Infiltration technique by using some other solutions such as articaine is an appropriate alteration for mandibular anesthesia. The aim of this study is to compare the efficacy of IANB using lidocaine with infiltration injection by articaine in mandibular second primary molar anesthesia in 8–11‑year‑old children.

This is a randomized, cross‑over, clinical trial that was performed on 42 children aged 8–11 years, who needed extraction of both mandibular second primary molars. After clinical and radiographic investigations, block or infiltration injection was chosen randomly and treatment was performed in one side in each session. Patient’s behavior was registered in two steps of injection and extraction by SEM scores.For comparison of the two sides,Wilcoxon–signed rank test was used (P < 0.05).

We concluded that infiltration technique resulted in decrease of all the three SEM scores in comparison to block injection (P < 0.05). The effectiveness of two techniques during tooth extraction,although grade of lidocaine block was more than infiltrate,was not statistically significant.

It seems that infiltration technique with articaine is a better substitute for block technique in the extraction of mandibular primary molars.

Recent scientific studies support the safe use of lidocaïne with adrenaline for anesthesia of the extremities (fingers, toes, nose, ear, penis), these studies push back the myth that advises against the use of local anesthetic substances with adrenaline in these areas [1-3]. Ingrown toenail is a common condition of the big toe. Surgery is often necessary. Ingrown toenail surgery is relatively straightforward and is usually performed under local anesthesia [3]. We report here a rare case of hallux necrosis secondary to local anesthesia by lidocaine 2% with adrenaline. The objective of this presentation is to warn practitioners about the observance of precautions before using local anesthetics with adrenaline for anesthetic procedures of the extremities.

Success in anesthesia administration relieves the perception of pain during surgery. Lidocaine is the most commonly used local anesthetic agent in clinical medicine. Moreover, anesthetic agents’ temperature changes can influence cell membrane permeability. Here, the effectiveness of different temperatures of Lidocaine (Lid.) on anesthesia success rate has been investigated in rats.

Wistar male rats were pretreated by fast injection of lidocaine or saline into the hind paw or intradermal cheek at Room Temperature (RT) and Body Temperature (BT) (22°C and 37°C, respectively). Then, rat behaviors were evaluated by formalin-induced hind paw pain and orofacial pain tests, respectively. Moreover, using a single-unit recording technique, the spontaneous activity of the marginal nerve was recorded at room temperature in the RT-Lid. and BT-Lid. groups.

Data analysis revealed that lidocaine had significant antinociceptive effects in both the BT-Lid. and RT-Lid. groups compared to the control groups (P<0.05). Also, the number of spikes in the BT-Lid. and RT-Lid. groups were significantly lower than their baselines (P<0.05). However, lidocaine at body temperature decreased the total time spent licking the hind paw, the number of lip rubbings, and the number of spikes firing by about 10%-15% compared to room temperature.

In both behavioral and neural levels of the study, our results showed that an increase in the temperature of lidocaine toward body temperature could increase anesthesia success rate compared to administration of lidocaine at room temperature. These findings can be considered in the treatment of patients.