Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa - a randomized cross-over study

A comparative evaluation of peppermint oil and lignocaine spray as topical anesthetic agents prior to local anesthesia in children: a randomized clinical trial

Background

In pediatric dentistry, fear and anxiety are common among children. Local anesthetics (LA) are widely used to control pain and reduce discomfort in children during dental treatment. Topical anesthetics play a vital role in reducing pain and the unpleasant sensation of a needle puncture in children. Peppermint oil has been extensively used for various diseases. However, its anesthetic properties remain unknown. Peppermint oil, used in mouthwashes, toothpastes, and other topical preparations has analgesic, anesthetic, and antiseptic properties. This study aimed to compare and evaluate pain perception following the topical application of peppermint oil versus lignocaine spray before an intraoral injection in children, aged 8-13 years.

Method

Fifty-two children, aged between 8-13 years, who required local anesthesia for dental treatment were divided into two groups of 26 each by simple random sampling (Group 1: 0.2% peppermint oil and Group 2: lignocaine spray). In both groups, physiological measurements (e.g., heart rate) were recorded using pulse oximetry before, during, and after the procedure. Objective pain measurement (Sound Eye Motor (SEM) scale) during administration and subjective measuremeant (Wong-Baker Faces Pain Rating Scale (WBFPRS)) after LA administration were recorded. This was followed by the required treatment of the child.Physiological parameters were compared between the two groups using an independent t-test for intergroup assessment and a paired t-test and repeated-measures ANOVA for intragroup comparisons. The Mann-Whitney U test was used to analyze the pain scores.

Results

Intragroup mean heart rates, before, during, and after treatment were statistically significantly different (P < 0.05). However, the intergroup mean pulse rates did not differ significantly between the two groups. The mean WBFPS score in the lignocaine spray group was 4.133 ± 2.06 was statistically different from that of the peppermint oil group (0.933 ± 1.03; P < 0.001*). The mean SEM score was significantly lower in the peppermint oil group than that in the lignocaine spray group (P = 0.006). No negative effects were observed in this study.

Conclusion

0.2% peppermint oil was effective in reducing pain perception.

Effectiveness of pre-injection use of cryoanesthesia as compared to topical anesthetic gel in reducing pain perception during palatal injections: a randomized controlled trial

Background

Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections.

Methods

A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test.

Results

The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869).

Conclusion

Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

Clinical Efficacy and Safety of Lidocaine Tape for Topical Anesthesia of the Oral Mucosa: A Preliminary Controlled Trial

Local anesthesia is administered to reduce pain-induced stress during dental treatment. However, local anesthetic injections are extremely painful; thus, methods to minimize this pain should be developed. Clinical studies on the pain-relieving effects of dental topical anesthetics have shown that few topical anesthetics provide fast and adequate pain relief without harming the oral mucosa. We examined the efficacy and safety of lidocaine tape, which has a potent topical anesthetic effect. Lidocaine tape was applied to the oral mucosa of 14 healthy participants, and its suppression effect was assessed by examining the pain intensity at the non-lidocaine tape-applied site using the visual analog evaluation scale and the verbal evaluation scale. Lidocaine tape application significantly reduced visual analog scale (VAS) scores during mucosal puncture compared to non-application (p < 0.01). Moreover, lidocaine tape application significantly reduced VAS scores during local anesthetic injection compared to non-application (p < 0.001). Adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 5.0. No adverse events attributed to the application of lidocaine tape were observed in any participant. The findings in this study suggest that the application of lidocaine tape before infiltration anesthesia can reduce patient distress.

Effectiveness of Aculief acupressure device on pain perception during local anesthesia in children: A double-blinded study

AIM

The aim of this study was to evaluate the effect of the Aculief acupressure device on the reduction of pain during local anesthesia (LA) in children and to compare it with the cryotherapy technique.

METHODOLOGY

20 children of age group between 6 and 9 years, requiring pulpectomy or extraction bilaterally were chosen for the study. After ethical clearance and parental consent, children who were not experienced to prior local anesthesia were chosen for the study. A split-mouth study design was done to avoid bias, and children were divided into two groups. During the first visit cryotherapy application was done on any one side followed by the LA, and during the second visit Aculief acupressure application was done, which was followed by the LA. The objective and subjective evaluation of pain during the LA was carried out and analyzed.

RESULTS

The objective perception of pain was evaluated using the Sound-Eye-Motor Scale by an observer who was blinded, and the subjective perception of pain by the Wong-Baker Faces Pain Rating Scale was evaluated by the child patient. The statistical analysis and comparison of values were done using the Wilcoxon signed-rank test. The pain during administration of LA was eliminated after the application of the Aculief acupressure device, and the results were superior to the cryotherapy technique.

CONCLUSION

The Aculief acupressure device can be effectively used to eliminate pain perception while administering LA in children. It is a simple, safe, noninvasive, and effective device and is easy to perform.

Efficacy of Eutectic Mixture of Local Anesthetics (EMLA) Versus Ice as Topical Anesthetics Prior to Long Buccal Nerve Blocks: A Prospective Comparative Study

Background Dental extraction is one of the common procedures in the field of dentistry. However, fear and anxiety about local anesthetic injections are unavoidable for most patients. Topical anesthetics, distraction techniques, acupuncture, and the application of heat or cold have been used in practice to alleviate injection-related pain. The specific aim of this study was to compare the pain-relieving efficacy of eutectic mixture of local anesthetics (EMLA) vs. ice during the administration of a long buccal nerve block (LBNB) before dental extraction. Materials and Methods In total, 20 healthy adult patients who required bilateral mandibular posterior teeth extraction under local anesthesia were enrolled. The study was conducted in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, from January 2023 to May 2023. It was a prospective split-mouth study in which each participant was divided into two groups according to the operative site: Group 1, which received a 5% EMLA cream, and Group 2, which received an application of ice before administration of LBNB. There was a one-week interval between the two interventions. The levels of pain and satisfaction were assessed using the visual analogue scale (VAS) and pain perception was evaluated by the sound, eye, motor (SEM) scale. Mann-Whitney U test was applied for the statistical analysis. Results The study included a total of 20 participants, with 14 being male and six being female. The mean age of the study population was 42 ± 15 years. When analyzing the pain scores using the VAS, it was found that Group 1 had a mean score of 2.4 ± 0.44, while Group 2 had a mean score of 3.0 ± 0.44. This difference between the two groups was statistically significant (P = 0.001). It was also found that the mean patient satisfaction score for Group 1 was 9.8 ± 0.22 and for Group 2 was 9.2 ± 0.40 which was statistically significant (p = 0.003). Similarly, Group 1 had a mean SEM score of 1.1 ± 0.1, while Group 2 had a mean SEM score of 1.30 ± 0.46 which was also statistically significant (P =0.016). Conclusion The study results revealed that EMLA has a significant advantage over ice in terms of lower levels of pain, more patient satisfaction, and higher comfort levels. EMLA can be considered the first choice of topical anesthetics, however, ice is recommended in resource-constrained dental set-ups as it is cost-effective.

Physiology of pregnancy and oral local anesthesia considerations

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.

Comparative Evaluation of Efficacy of EMLA Versus Ice as Topical Anesthetic in Prior to Needle Prick in Palatine Nerve Blocks-A Randomized Split Mouth Study EMLA Versus Ice as Topical Anesthetic in Dental Nerve Blocks

Background and Objectives

The study aims to evaluate the pain efficacy of EMLA versus ice in palatine nerve blocks undergoing extraction.

Materials and Methods

A prospective randomized study, single-blind, split-mouth study carried out on a total of 20 healthy individuals needing extraction of bilateral maxillary teeth under local anesthesia referred to our department in the university from March 2021 to April 2022. Patients were randomly categorized into two groups: Group E (5% EMLA) and Group I (ice application), with 20 operative sites, respectively. In the study, the VAS-pain and satisfaction score and SEM score were analyzed. Statistical analysis was done using SPSS version 20.0 software using the Mann-Whitney U test.

Results

Study results showed that 13 patients were men and 7 were women whose ages ranged from 46 ± 18 years. Statistical analysis of pain on the VAS scale showed that the mean score for Group E and Group I were 2.3 ± 0.47 and 3.2 ± 0.41(mean ± SD), respectively, which was statistically significant (P < 0.001). On the statistical analysis of the SEM scale for Group E and Group I, the mean score was 1.00 ± 0.00 and 1.25 ± 0.44426 (mean ± SD), respectively, which was statistically significant (P < 0.018).

Conclusion

EMLA and ice were both good topical anesthetics each with advantages and disadvantages in clinical use. Each clinician needs to weigh the pros and cons of the different available methods and expenses to determine what type of anesthetic to use for each particular case during treatment.

Recent Advances in Local Anesthesia: A Review of Literature

Even if local anesthetic is still the mainstay of pain management in dentistry, research will keep striving for novel and effective pain management techniques. The majority of research efforts are focused on improving anesthetic medications, delivery systems, and related methods. There are more recent technologies available that can assist the dentist in providing better pain relief with fewer unpleasant injections and fewer negative adverse effects. The purpose of the current review of the literature is to compile evidence that will convince dentists to employ modern local anesthetics, as well as other methods and techniques to reduce patient discomfort while administering anesthesia.

Comparison of Three Anaesthetic Options to Reduce Acute Pain Response in Kid Goats

Three options for anesthetizing the skin around the horn bud of dairy goat kids were explored. Forty-five <10-day-old Saanen goat kids from were randomly split into five treatment groups (topical anesthetic cream (TA), vapocoolant spray (VS), local anesthetic applied by jet injector (JI), control - no treatment but painful stimulus applied (C), sham - no treatment and touching sites with a finger. The painful stimulus was multiple needle pricks on the skin around the horn bud. The outcome variables measured were heart rate movement, and vocalization during treatment application and administration of a painful stimulus around the horn bud. Heart rates were greater during application of a VS compared to TA.Neither the TA nor the VS appeared to have any effect on the response to the painful stimulus. Kids in the JI group had a 96% reduced odds of expressing a marked pain response in comparison to TA group and an 83% reduction in the odds of a high movement grade during a painful procedure in comparison to the combined results of the other three treatment groups.

Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique

Aim

To compare freezed cone and 5% lignocaine as a numbing agent before intraoral injection and evaluate the effect of virtual reality distraction (VRD) as a distraction technique in reducing pain perception in children.

Study design

Around 60 children of 6-11 years old undergoing treatment for the extraction or any pulp therapy of primary tooth were selected. Freezed cone and 5% lidocaine were used to decrease the pain during local anesthesia (LA). VRD was used as a distraction method and to analyze the pain perception, Wong-Baker Faces Pain Rating Scale was used.

Materials and methods

Each child was randomly assigned to receive ice as a topical anesthetic or lignocaine 5% as a topical anesthetic agent. The pain perception was evaluated after the injection of 2% lignocaine hydrochloride (HCL). The primary researcher evaluated the pain during injection using the sound, eye, motor (SEM) scale. The pain experienced during injection was evaluated using Wong-Baker Faces Pain Rating Scale.

Results

In the freezed cone group with the VRD technique, maximum responded to the less pain score. On the contrary, many responded to higher pain scores in the freezed cone group without the VRD technique.

Conclusion

It was concluded that the VRD technique can be used for distraction and the frozen ice cone can be an alternative method to reduce the pain perception during LA.

How to cite this article

Singh R, Gupta N, Gambhir N. Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique. Int J Clin Pediatr Dent 2022;15(5):558-563.

Efficacy of Cryotherapy Application on the Pain Perception during Intraoral Injection: A Randomized Controlled Trial

Background

Profound local anesthetic delivery promotes successful treatment for children in terms of easing their fear, anxiety, and discomfort during dental procedures. Local anesthetic injections are the utmost anticipated or anxious stimuli in the dental operatory. Precooling the oral mucosa by application of cryotherapy before local anesthetic injections can alter the pain perception in children.

Aim and objectives

To compare the efficacy of cryotherapy application and 20% benzocaine gel at reducing pain perception during buccal infiltration in pediatric patients.

Materials and methods

In this split-mouth study, 30 pediatric patients between 7 years and 10 years of age who needed maxillary buccal infiltration of local anesthetics bilaterally for dental treatment were selected. They received cryotherapy (ice pack) on one quadrant (test group) for 2 minutes and 20% benzocaine topical gel on the contralateral quadrant (control group). A pediatric dentist blinded to the study assessed sound, eye, motor (SEM) scale based on patients’ reaction during injection (objective method), and patients were instructed to use a visual analog scale (VAS) to rate their distress during injection (subjective method). Statistical analyses were performed using Wilcoxon and Mann–Whitney U tests.

Results

The cryotherapy group had significantly reduced pain scores on the VAS scale (40.66 ± 14.60) when compared with the topical anesthetic gel group (61.33 ± 9.73). The cryotherapy group had reduced pain scores on the SEM scale as well (1.2 ± 0.1) when compared with the topical anesthetic gel group (1.6 ± 0.1), which was not statistically significant.

Conclusion

When compared with topical anesthetic gel, precooling the injection site with cryotherapy is beneficial in reducing pain before local anesthesia injection in pediatric patients.

Clinical significance

Cryotherapy application eliminates the fear of pain ascribed to injection of local anesthesia and assists in providing pertinent dental care.

How to cite this article

Lakshmanan L, Ravindran V. Efficacy of Cryotherapy Application on the Pain Perception during Intraoral Injection: A Randomized Controlled Trial 2021;14(5):616–620.

Comparative evaluation of pain perception following topical application of clove oil, betel leaf extract, lignocaine gel, and ice prior to intraoral injection in children aged 6-10 years: a randomized control study

Background

In the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children.

Methods

Sixty children aged 6–10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion. The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05.

Results

The clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant.

Conclusion

Betel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.

Comparison of Lidocaine Spray and Lidocaine Ice Popsicle in Patients Undergoing Unsedated Esophagogastroduodenoscopy: A Single Center Prospective Randomized Controlled Trial

Purpose

Esophagogastroduodenoscopy (EGD) under topical pharyngeal anesthesia has the advantage of avoiding the unwanted cardiopulmonary adverse events experienced following intravenous sedation. Lidocaine spray is a common anesthetic option and is safe for unsedated EGD. Although several studies have compared different topical anesthetic agents, their formulations, and delivery techniques, questions still remain concerning the optimal mode of administration. We have designed a lidocaine formulation in the form of an ice popsicle and compared its effectiveness and tolerability with lidocaine spray in patients undergoing unsedated EGD.

Methods

This was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray [Group (Gp) A] or lidocaine ice popsicle (Gp B) formulation.

Results

In total, 204 unsedated EGD patients were evaluated. Compared to the spray, the lidocaine ice popsicle group showed better scores for effects in terms of endoscopist satisfaction (Gp A, 7.28±1.44; Gp B, 7.8±0.89; p=0.0022), gag reflex (Gp A, 1.3±0.66; Gp B, 1.02±0.61; p=0.0016), patient satisfaction (Gp A, 7.74±0.82; Gp B, 8.08±0.82; p=0.0039), discomfort (Gp A, 6.54±1.34; Gp B, 5.95±1.21; p=0.0012), and pain (Gp A, 5.38±1.85; Gp B, 4.51±2.01; p=0.0015).

Conclusion

Both the lidocaine spray and ice popsicle formulations are safe, effective options for diagnostic EGD with the ice popsicle exhibiting better performance. We propose the lidocaine ice popsicle formulation for topical pharyngeal anesthesia in patients undergoing unsedated diagnostic EGD and suggest it may be a suitable option during the COVID-19 pandemic.

Clinical Trial Register

Thai Clinical Trials Registry (TCTR) number TCTR20190502001.

Lipid nanocapsules loaded with prilocaine and lidocaine and incorporated in gel for topical application

Lipid nanocapsules (LNC) are special drug delivery system (DDS) carriers obtained by the phase-inversion temperature method (PIT). This study describes the encapsulation of the local anesthetics (LA) prilocaine (PLC) and lidocaine (LDC) in lipid nanocapsules (LNC_PLC+LDC) optimized by 2³ factorial design, characterized through DLS, NTA, CRYO-EM and release kinetics and incorporated in carbopol gel (Gel_{LNC PLC+LDC}) prior to in vivo anesthetic effect (in mice) evaluation. A very homogeneous population of small (50 nm; polydispersity index = 0.05) spherical nanocapsules with negative zeta potentials (-21 mV) and ca. 2.3 × 10¹⁵ particles/mL was obtained. The encapsulation efficiency was high (81% and 89% for prilocaine and lidocaine, respectively). The release rate profile was free PLC = free LDC > LNC_PLC+LDC > Gel_{LNC PLC+LDC}. The hybrid system increased (4x) the anesthesia time in comparison to an equipotent gel formulation prepared without LNC. No tissue damage was detected on the tail skin of mice that received the formulations. This study shows that lipid nanocapsules are suitable carriers for PLC and LDC, promoting longer and safer topical anesthesia. Gel_{LNC PLC+LDC} is mucoadhesive and suitable for application in the mouth, where it could be used as a pre-anesthetic, to reduce pain of needle stick (infiltrative anesthesia).

Effect of photobiomodulation on pain level during local anesthesia injection: a randomized clinical trial

The aim of this study was to investigate the effect of photobiomodulation therapy (PBMT) as pre-treatment on pain level during injection in the anterior maxillary region. 56 Patients were randomly divided into 3 groups, Group 1:980 nm diode laser (n = 22) (experimental), Group 2:980 nm diode laser probe placed in vestibule without radiation (placebo) (n = 22), Group3: no pre-treatment before injection (n = 12) (control). Pain level during injection was evaluated by visual analog scale (VAS). The severity of pain in Group 1(experimental) and Group 2 (placebo) was significantly lower than Group 3 (control). Group 1 had a lesser pain level than Group 2, but the difference in pain level between them was not significant. PBMT with 980 nm wavelength decreased pain level during local anesthesia injection without superiority over placebo.