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Zhou X, Zhong Y, Pan Z, Zhang J, Pan J. Physiology of pregnancy and oral local anesthesia considerations. PeerJ 2023; 11:e15585. [PMID: 37404472 PMCID: PMC10315135 DOI: 10.7717/peerj.15585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background 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. Methodology 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. Results 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. Conclusions 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.
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Affiliation(s)
- Xueer Zhou
- 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
| | - Yunyu Zhong
- 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
| | - Zijian Pan
- 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
| | - Jiankang Zhang
- 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
- Chengdu Advanced Medical Science Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jian Pan
- 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
- Chengdu Advanced Medical Science Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Gómez-Sánchez E, Franco-de la Torre L, Bologna-Molina RE, Molina-Frechero N, Serafín-Higuera NA, Hernández-Gómez A, Alonso-Castro ÁJ, Sat-Muñoz D, Isiordia-Espinoza MA. Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101867. [PMID: 36292314 PMCID: PMC9602303 DOI: 10.3390/healthcare10101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Symptomatic irreversible pulpitis is a painful clinical condition with a broad inflammatory component. Dental anesthesia in these patients is affected by the inflammatory process, reporting a high incidence of anesthesia failure. The aim of this systematic review and meta-analytical evaluation was to determine the effect of pre-treatment with tramadol in patients with symptomatic irreversible pulpitis, as well as for pain control and adverse effects. This study was registered in PROSPERO (ID: CRD42021279262). PubMed was consulted to identify clinical investigations comparing tramadol and placebo/local anesthetics in patients with symptomatic irreversible pulpitis. Data about the anesthesia, pain control, and adverse effects were extracted. Both the anesthetic success index and the adverse effects of local tramadol and placebo were compared with the Mantel−Haenszel test and odds ratio. Data analysis showed that the local administration of tramadol increased the anesthetic success rate when compared to placebo in patients with symptomatic irreversible pulpitis (n = 228; I2 = 0; OR = 2.2; 95% CIs: 1.30 to 3.79; p < 0.004). However, local administration of tramadol increased the risk of adverse effects when compared to placebo/local anesthetics (n = 288; I2 = 0; OR = 7.72; 95% CIs: 1.37 to 43.46; p < 0.02). In conclusion, this study shows that the local administration of tramadol increases the anesthetic success index when compared to placebo in patients with symptomatic irreversible pulpitis.
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Affiliation(s)
- Eduardo Gómez-Sánchez
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad (UDG-CA-874), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
| | | | - Nelly Molina-Frechero
- Departamento de Salud, Laboratorio de Cariología y Medicina Oral, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 04960, Mexico
| | | | - Adriana Hernández-Gómez
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Jalisco, Mexico
| | - Ángel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato City 36050, Guanajuato, Mexico
| | - Daniel Sat-Muñoz
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad (UDG-CA-874), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
- Correspondence: ; Tel.: +52-(378)-119-57-86
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Tirupathi SP, Afnan L, Alahari S, Challa R. Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis. Ann Maxillofac Surg 2022; 12:203-211. [PMID: 36874780 PMCID: PMC9976844 DOI: 10.4103/ams.ams_149_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/19/2022] [Accepted: 11/13/2022] [Indexed: 01/12/2023] Open
Abstract
Background Adrenaline or clonidine is used as adjuncts in conjunction with lignocaine to improve the depth of local anaesthesia in dental procedures. Objectives This systematic review and meta-analysis intends to compare the haemodynamic parameters when clonidine or adrenaline is used in conjunction with lignocaine for third-molar surgical removal. Data Sources Cochrane, PubMed and Ovid SP databases were searched using "MeSH" terms (((nerve block) OR (IANB)) AND ((clonidine) OR (adrenaline))) AND (lignocaine). Study Eligibility Criteria Clinical studies where Clonidine + lignocaine and Adrenaline + lignocaine were compared directly during nerve block administration exclusively for third molar surgical removal were selected. Participants Study Appraisal This current systematic review is registered in Prospero database CRD42021279446. Two independent reviewers were involved in collection, segregation and analysis of electronic data. The data were compiled in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search was conducted till June 2021. Synthesis Methods Qualitative analysis of the selected articles was performed for systematic review. Meta-analysis is performed using RevMan 5 Software. Heterogeneity through the I2 statistics. Change in the haemodynamic parameters was the primary outcome evaluated, and secondary outcomes evaluated were onset and duration of anaesthesia in both the groups. Results In all databases, 1141 records were screened, out of which a total of 21 articles were included for the evaluation for full-text analysis. Out of these, 16 articles were excluded and 5 articles were included for the final systematic review. Meta-analysis was performed only for 4 studies. Conclusion Amongst the evaluated haemodynamic parameters, there was a significant reduction in the heart rate (baseline to intraoperative period) in clonidine and lignocaine groups than in adrenaline and lignocaine groups during nerve block administration for third molar surgical removal. There was no significant difference between other primary and secondary outcomes evaluated. Limitations Blinding was not performed in all the studies, randomisation was performed in only three studies. The volume of local anaesthesia deposited varied in the studies (2 mL in three studies and 2.5 mL in two studies). Most of the studies (n = 4) were evaluated on normal adults and only one study evaluated mild hypertensive patients.
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Affiliation(s)
- Sunny Priyatham Tirupathi
- Department of Pedodontics and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Lamea Afnan
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Swetha Alahari
- Department of Pedodontics and Preventive Dentistry, Dr. Hegdewar Smruti Rugna Seva Mandals Dental College and Hospital, Parola, Maharashtra, India
| | - Ramasubbareddy Challa
- Department of Pedodontics and Preventive Dentistry, Dr. Hegdewar Smruti Rugna Seva Mandals Dental College and Hospital, Parola, Maharashtra, India
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Iranmanesh P, Khazaei S, Nili M, Saatchi M, Aggarwal V, Kolahi J, Khademi A. Anesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta‐analysis and trial sequential analysis. Int Endod J 2022; 55:732-747. [DOI: 10.1111/iej.13746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Pedram Iranmanesh
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Saber Khazaei
- Department of Endodontics School of Dentistry Kermanshah University of Medical Sciences Kermanshah Iran
| | - Mahsa Nili
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Masoud Saatchi
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics Faculty of Dentistry Jamia Millia Islamia New Delhi India
| | - Jafar Kolahi
- Independent Research Scientist, Founder and Associate Editor of Dental Hypotheses Isfahan Iran
| | - Abbasali Khademi
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
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Chen LS, Nusstein J, Drum M, Fowler S, Reader A, Guo X. Effect of a Combination of Nitrous Oxide and Intraligamentary Injection on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis. J Endod 2021; 47:1890-1895. [PMID: 34492232 DOI: 10.1016/j.joen.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purpose of this prospective study was to determine the effect of a combination of nitrous oxide/oxygen and 1 set of supplemental intraligamentary/periodontal ligament (PDL) injections followed by a second set of PDL injections on anesthetic success in patients with symptomatic irreversible pulpitis (SIP). METHODS Ninety-four patients with a mandibular posterior tooth diagnosed with SIP received nitrous oxide/oxygen and an inferior alveolar nerve block (IANB) with 2% lidocaine with 1:100,000 epinephrine. Patients rated the pain of PDL injections and endodontic access on a visual analog scale. If moderate to severe pain was felt during treatment, the operator administered 1 set of supplemental PDL injections with 4% articaine with 1:100,000 epinephrine. If moderate to severe pain was felt again during treatment, the operator administered a second set of supplemental PDL injections. Anesthetic success was defined as having no to mild pain during endodontic treatment. RESULTS The success of the IANB with nitrous oxide was 44% (95% confidence interval [CI], 34%-54%). The overall anesthetic success rate (IANB with PDL injections) was increased from 69% (95% CI, 60%-78%) with 1 set of PDL injections to 80% (95% CI, 72%-88%) with a second set of PDL injections. CONCLUSIONS Although the second set of PDL injections increased anesthetic success, it was not sufficient to ensure complete pulpal anesthesia.
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Affiliation(s)
- Lo-Shen Chen
- Practice Limited to Endodontics, Worthington, Ohio
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - Sara Fowler
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Xiaohan Guo
- Division of Biostatistics, The Ohio State University, Columbus, Ohio
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Aminoshariae A, Azarpazhooh A, Diogenes AR, Fouad AF, Glickman GN, Kishen A, Letra AM, Levin L, Roda RS, Setzer FC, Tay FR, Hargreaves KM. Insights into the April 2021 Issue of the Journal of Endodontics. J Endod 2021; 47:555-557. [PMID: 33662436 DOI: 10.1016/j.joen.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Anibal R Diogenes
- University of Texas Health San Antonio School of Dentistry, San Antonio, Texas
| | | | | | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Ariadne M Letra
- University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | | | | | - Frank C Setzer
- Diplomate, American Board of Endodontics; Assistant Professor, Clinic & Predoctoral Program and Director, Department of Endodontics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, Georgia
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