Trigeminal nerve paraesthesia from inferior alveolar nerve blocks: incidence and course

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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A Prospective, Randomized, Double-blind Comparison of Bupivacaine and Lidocaine for Inferior Alveolar Nerve Blocks

Yearbook of Dentistry ◽

10.1016/s0084-3717(08)70218-6 ◽

2006 ◽

Vol 2006 ◽

pp. 275-276

Author(s):

W.T. Johnson

Keyword(s):

Inferior Alveolar Nerve ◽

Nerve Blocks ◽

Double Blind ◽

Blind Comparison

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Anesthetic Efficacy of a Combination of 0.5 M Mannitol Plus 127.2 mg of Lidocaine With 50 μg Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single-Blind Study

Anesthesia Progress ◽

10.2344/11-00040.1 ◽

2013 ◽

Vol 60 (1) ◽

pp. 3-10 ◽

Cited By ~ 7

Author(s):

Steven Smith ◽

Al Reader ◽

Melissa Drum ◽

John Nusstein ◽

Mike Beck

Keyword(s):

Postoperative Pain ◽

Inferior Alveolar Nerve ◽

Blind Study ◽

Maximum Output ◽

Nerve Blocks ◽

Posterior Teeth ◽

Solution Deposition ◽

The Times ◽

Pulpal Anesthesia ◽

Single Blind

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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