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jtitle_s:("anesti Prog")
1.  Effect of Massage on the Efficacy of the Mental and Incisive Nerve Block 
Anesthesia Progress  2013;60(1):15-20.
The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB). Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1 : 80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection. The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests. Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments. We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.
doi:10.2344/12-00024.1
PMCID: PMC3601725  PMID: 23506279
Dental pulp anesthesia; Lidocaine; Mental and incisive nerve block
2.  Factors Influencing the Discomfort of Intraoral Needle Penetration 
Anesthesia progress  2005;52(3):91-94.
This study with 24 volunteers compared the discomfort produced by needle penetration in different parts of the palatal mucosa. In addition, comparing a fresh needle to one that was used for a previous penetration in the same patient, we assessed the influence of the status of the needle on insertion discomfort during buccal mucosal penetration. The results showed that needle penetration in the anterior hard palate was more uncomfortable than in the posterior palate. Although men could not differentiate between fresh and used needles for a second buccal mucosal penetration, women reported a significant increase in discomfort with used needles.
doi:10.2344/0003-3006(2005)52[91:FITDOI]2.0.CO;2
PMCID: PMC1586791  PMID: 16252738
Injection discomfort; Intraural injection; Dental local anesthesia; Needles
3.  A comparison of intraoral injection discomfort produced by plain and epinephrine-containing lidocaine local anesthetic solutions: a randomized, double-blind, split-mouth, volunteer investigation. 
Anesthesia Progress  2002;49(2):44-48.
The authors report a clinical trial designed to compare the discomfort produced by plain and epinephrine-containing lidocaine solutions during local anesthesia in the maxilla. Twenty-four healthy volunteers were recruited; each received buccal and palatal infiltrations on each side of the maxilla in the premolar region. The solutions were 2% lidocaine and 2% lidocaine with 1:80,000 epinephrine. Allocation to side was randomized and operator and volunteer were blinded to the identity of the solutions. Volunteers recorded injection discomfort on a 100-mm visual analogue scale (VAS). Volunteers were included in the trial if a score of at least 30 mm was recorded for at least 1 of the matched pair of injections. Differences between treatments were measured using Student's paired t test. Twelve volunteers recorded a VAS score of at least 30 mm for 1 or both buccal injections, and 17 volunteers reached this score for palatal injections. Buccal injection pain was less when the plain solution was used (P = .04) and was not influenced by the order of the injection. Palatal injection discomfort did not differ between the solutions; however, the second palatal injection was more uncomfortable than the first palatal injection (P = .046). These results suggest that plain lidocaine produces less discomfort than lidocaine with epinephrine when administered into the maxillary premolar buccal sulcus in individuals who report moderate pain during this injection. Palatal injection discomfort does not differ between these solutions.
PMCID: PMC2007391  PMID: 15384291
4.  The use of EMLA for an intraoral soft-tissue biopsy in a needle phobic: a case report. 
Anesthesia Progress  2001;48(1):32-34.
A case is reported of the removal of a leaf fibroma from the mucosa of the hard palate using EMLA topical anesthesia as the sole means of pain control.
Images
PMCID: PMC2007330  PMID: 11495404
5.  Local anesthesia in the palate: a comparison of techniques and solutions. 
Anesthesia Progress  2000;47(4):139-142.
It was the purpose of the present investigation to determine if there were differences in soft-tissue anesthesia in the palate following infiltration and greater palatine nerve block anesthesia and to compare lidocaine with lidocaine plus epinephrine as palatal soft tissue anesthetics. Two studies using 10 volunteers were performed. In one trial, volunteers received a palatal infiltration opposite the second maxillary bicuspid on one side and a greater palatine nerve block on the other. Response to sharp probing and pain-pressure thresholds were measured on each side over a 1-hour census period. In the second trial, volunteers received 2% plain lidocaine as a palatal infiltration on one side and a similar infiltration of 2% lidocaine with 1:80,000 epinephrine on the other in a double-blind randomized fashion. Response to sharp probing was assessed over a 55-minute period. Data were analyzed using Student's paired t tests. The response to sharp probing and pressure-pain thresholds did not differ between palatal infiltration and greater palatine nerve block over the 1-hour period. Lidocaine with epinephrine provided longer lasting anesthesia than plain lidocaine following palatal infiltration (P < .001). Greater palatine nerve block and palatal infiltration provide similar soft-tissue anesthesia. Lidocaine with epinephrine produces longer-lasting soft-tissue anesthesia than plain lidocaine following palatal infiltration.
PMCID: PMC2149034  PMID: 11432180
6.  Plasma potassium changes in hypertensive patients undergoing oral surgery with local anesthetics containing epinephrine. 
Anesthesia Progress  1997;44(3):106-109.
Blood pressure, heart rate, and plasma potassium concentration were measured before and 10 min following the injection of 4.4 ml of 2% lidocaine with 1:80,000 epinephrine in 14 patients receiving treatment for hypertension. Patients were divided into two groups. Group 1 was receiving treatment with non-potassium-sparing diuretics and group 2 was being treated with nonselective beta-adrenergic antagonists. No significant changes in systolic or diastolic blood pressures were detected between groups at 10 min. The change in heart rates from the preinjection value differed between groups at 10 min (P < 0.02). Ten minutes following the injection of the local anesthetic, plasma potassium concentration was significantly reduced in group 1 patients compared to both baseline and the change in group 2 patients (P < 0.05).
PMCID: PMC2148929  PMID: 9481971
7.  Epinephrine, magnesium, and dental local anesthetic solutions. 
Anesthesia Progress  1996;43(4):99-102.
Plasma levels of magnesium were unaffected by the inclusion of epinephrine in lidocaine dental local anesthetic solutions in patients having third molar surgery under general anesthesia.
PMCID: PMC2148774  PMID: 10323114
8.  A comparison of the effects of EMLA cream and topical 5% lidocaine on discomfort during gingival probing. 
Anesthesia Progress  1995;42(1):7-10.
This investigation compared the use of a 5% eutectic mixture of local anesthetics (EMLA) cream to a "standard" intraoral topical anesthetic (5% lidocaine) as a means of anesthetizing the gingival sulcus in a double-blind, split-mouth study with human volunteers. A 5-min application of EMLA in a customized intraoral splint resulted in a significant increase in the depth of probing of the gingival sulcus without discomfort compared to a similar application of 5% lidocaine. Following application of EMLA, the pain-free probing depth measured at three sites in the upper premolar region increased by a mean total of 2.8 mm compared to an increase of 1.9 mm with lidocaine. This study suggests EMLA may be advantageous in providing periodontal anesthesia where manipulation of the gingiva is necessary.
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PMCID: PMC2148873  PMID: 8934955
9.  Metabolic responses to oral surgery under local anesthesia and sedation with intravenous midazolam: the effects of two different local anesthetics. 
Anesthesia Progress  1992;39(1-2):9-12.
The effects of epinephrine-free and epinephrine-containing local anesthetic solutions on plasma potassium and blood glucose concentrations were investigated in 20 patients undergoing oral surgery with intravenous midazolam sedation. Ten patients were randomly assigned to receive 4.4 mL of 2% lidocaine with 1:80,000 epinephrine as a local anesthetic and 10 were given 4.4 mL of 3% prilocaine with 0.03 IU/mL felypressin. There were significant changes from baseline potassium and glucose concentrations both within and between treatments in the early postinjection period. The epinephrine-containing local anesthetic significantly reduced the plasma potassium concentration 10 min after injection, by 0.16 +/- 0.20 mmol/L (mean +/- SD), and increased the blood glucose concentration at 10, 20, and 30 min (by 0.46 +/- 0.37, 0.63 +/- 0.45, and 0.56 +/- 0.28 mmol/L, respectively). Conversely, plasma potassium increased and blood glucose decreased 10, 20, and 30 min following the administration of the epinephrine-free solution. At 30 min potassium was increased by 0.24 +/- 0.16 mmol/L, and glucose was decreased by 0.23 +/- 0.16 mmol/L. It is concluded that epinephrine-free and epinephrine-containing local anesthetics differ in their metabolic effects during oral surgery with midazolam sedation.
PMCID: PMC2148719  PMID: 8507025

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