Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks

Abstract The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of 127.2 mg lidocaine with 50 μg epinephrine compared to 127.2 mg lidocaine with 50 μg epinephrine plus 0.5 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 3.18 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine and a 5 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine (3.18 mL) plus 0.5 M mannitol (1.82 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. Pain of solution deposition and postoperative pain were also measured. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings) over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that a 5 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine plus 0.5 M mannitol was significantly better than the 3.18 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine for all teeth. Solution deposition pain and postoperative pain were not statistically different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia than a lidocaine formulation without mannitol.

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The Effect of 2 Injection Speeds on Local Anesthetic Discomfort During Inferior Alveolar Nerve Blocks

Anesthesia Progress ◽

10.2344/11-00037.1 ◽

2015 ◽

Vol 62 (3) ◽

pp. 106-109 ◽

Cited By ~ 4

Author(s):

Marcelo Rodrigo de Souza Melo ◽

Mark Jon Santana Sabey ◽

Carla Juliane Lima ◽

Liane Maciel de Almeida Souza ◽

Francisco Carlos Groppo

Keyword(s):

Pain Perception ◽

Crossover Trial ◽

Healthy Adult ◽

Inferior Alveolar Nerve ◽

Needle Insertion ◽

Test Results ◽

Nerve Blocks ◽

Double Blind ◽

Significant Difference ◽

Adult Volunteers

Abstract This randomized double-blind crossover trial investigated the discomfort associated with 2 injection speeds, low (60 seconds) and slow (100 seconds), during inferior alveolar nerve block by using 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine. Three phases were considered: (a) mucosa perforation, (b) needle insertion, and (c) solution injection. Thirty-two healthy adult volunteers needing bilateral inferior alveolar nerve blocks at least 1 week apart were enrolled in the present study. The anesthetic procedure discomfort was recorded by volunteers on a 10-cm visual analog scale in each phase for both injection speeds. Comparison between the 2 anesthesia speeds in each phase was performed by paired t test. Results showed no statistically significant difference between injection speeds regarding perforation (P = .1016), needle placement (P = .0584), or speed injection (P = .1806). The discomfort in all phases was considered low. We concluded that the 2 injection speeds tested did not affect the volunteers' pain perception during inferior alveolar nerve blocks.

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Intravenous cannula used for continuous intraoral mandibular nerve block in trigeminal neuralgia

BMJ Case Reports ◽

10.1136/bcr-2020-240368 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240368

Author(s):

Harriet Katharine Stringer ◽

Farzad Borumandi

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Inferior Alveolar Nerve ◽

Oral Intake ◽

Nerve Blocks ◽

Chronic Pain Condition ◽

Intravenous Cannula ◽

The Third

Trigeminal neuralgia is a chronic pain condition affecting one or more distributions of the trigeminal nerve. Patients with this condition experience short, sharp, shooting pain attacks, which can progress to longer, more frequent durations. The pain is often difficult to control. We report of a man who was admitted with severe neuralgia of the third division of the trigeminal nerve. Talking and any oral intake triggered a severe agonising pain. The latter made the regular oral intake of analgesia challenging. The pain was temporarily controlled with frequent local anaesthesia (LA). Dental core trainees were performing regular inferior alveolar nerve blocks which significantly improved patients’ condition allowing him to communicate and have oral intake. Subsequently, a catheter was placed allowing for a continuous anaesthesia. The connecting tube of the cannula was then used by nursing staff to administer LA providing pain relief without the need of repeated intraoral injections.

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Inferior alveolar nerve blocks for postoperative pain control after mandibular distraction with osteotomies in a neonate

Pediatric Anesthesia ◽

10.1111/pan.12379 ◽

2014 ◽

Vol 24 (6) ◽

pp. 635-637 ◽

Cited By ~ 3

Author(s):

David J. Krodel ◽

Dawn Belvis ◽

Santhanam Suresh

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Inferior Alveolar Nerve ◽

Postoperative Pain Control ◽

Nerve Blocks ◽

Mandibular Distraction

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Applied Anatomy of the Maxillofacial and Mandibular Regions of Indian Mithun (Bos frontalis) and its Clinical Significance in Regional Anesthesia

Indian Journal of Animal Research ◽

10.18805/ijar.b-4177 ◽

2020 ◽

Author(s):

O.P. Choudhary ◽

Priyanka . ◽

P.C. Kalita ◽

Keneisenuo . ◽

B. Konwar ◽

...

Keyword(s):

Clinical Significance ◽

Regional Anesthesia ◽

Head Region ◽

Nerve Blocks ◽

Surgical Interventions ◽

Applied Anatomy ◽

Significant Statistical Difference ◽

Intraoral Approach ◽

Males And Females ◽

Different Parts

Background: The topographic and morphometric anatomy of various foramina provides an easy approach in performing nerve blocks by their proper tracking for regional anesthesia in surgical interventions. There is no previously reported information on the applied anatomy and clinical significance of the maxillofacial and mandibular regions of the Indian mithun. The present study was designed to provide important clinical landmarks related to tracking of the infraorbital, mental and mandibular nerves with its clinical significance in regional anesthesia in mithun. Methods: The study was conducted on the maxillofacial and mandibular regions of twelve (n=12) adult Indian mithun of either sex (n=6, male and n=6, female). The head region samples of naturally died mithun were collected from different parts of the Mizoram and Nagaland state of India and processed as per the standard maceration technique. Altogether, a total of twelve measurements were taken in the maxillofacial and mandibular regions of mithun by using a digital vernier caliper and the results were expressed as mean±standard deviation. The obtained parameters from the present study can be useful for an extraoral and intraoral approach for nerve block of the infraorbital, mental and mandibular nerve in the maxillofacial and mandibular regions of mithun. Result: The present study revealed that all the obtained parameters related to regional anesthesia showed a significant statistical difference (P less than 0.01** and P less than 0.05*) between the males and females of mithun. It can be concluded from the present study that the various applied parameters of the present study will aid the clinicians in the implication of regional anesthesia in the head region of mithun.

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