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Comparison Between Intranasal and Traditional Injection Anesthetics
Anesthesia Progress – Local anesthetics are paramount for pain management during dental procedures. Typically, these anesthetics are administered via injection; however, many patients suffer from trypanophobia, or the fear of needles during a medical procedure, which leads to those patients not receiving the dental care they need, consequently negatively impacting both their oral and overall whole-body health.
To assist in finding a solution for patients with trypanophobia, researchers from the Louisiana State University, New Orleans, Ohio State University, Columbus, and the University of Michigan, Ann Arbor, recently published a double-blind, cross-over design study in the current issue of Anesthesia Progress that compared pain and pupal blood flow (PBF) levels when using an anesthetic nasal spray versus traditional injection..
A total of 20 patients, 10 male and 10 female with an average age of approximately 27 years, were included in this study. Each participant attended three visits, spaced two weeks apart, in which they were given a combination of the following: Kavanaze nasal spray (KNS) and mock infiltration; mock nasal spray and epinephrine (LE) injection; or mock nasal spray and mepivacaine plane (MP) injection. On each visit, the participant was given different combination of anesthetic, so they received all three variations by trail endpoint..
At six different, off-setting time intervals, PBF was assessed by laser Doppler flowmetry and anesthetic efficiency was tested using an electric pulse tester. Pain levels were measured via the Heft-Parker Visual Analog Scale at three-time intervals post-procedure. The researchers found that only the LE group saw a significant decrease in PBF at each measured time interval. The LE group was also correlated with a significantly higher percentage of successful pupal anesthesia versus the KNS and MP groups. The researchers also noted that the KNS group had higher pain score levels at each time interval and reported more adverse reactions compared with the LE and MP groups. Most participants preferred the traditional injection anesthetic versus the nasal spray; there was no difference in preference between the LE and MP groups..
The results of this study suggest that the use of KNS did not demonstrate a level of pulpal anesthesia congruent to that of LE and MP. Study author Scott Thayer, DDS, MD, stated, the “use of local anesthetics as a means of pain management is essential for dental practitioners. Kovanaze provides an alternative approach in the delivery of anesthetics and showed promising results in previous clinical trials. [This] research looked to evaluate Kovanaze, not only for anesthetic efficacy, but also on effects on pulpal blood flow and patient satisfaction. Although anesthetic effects on pulpal blood flow is a highly debatable topic, some guidelines still advocate the use of local anesthetics without a vasoconstrictor. [Our] hope was to evaluate the effects on pulpal blood flow with Kovanaze and to spark further discussion and research on the matter.” Although the results of this study did not show the use of KNS to be more well-received than that of traditional injection anesthesia, Thayer concludes by saying, “the findings provided data regarding the preference of traditional local anesthetics due to complications following Kovanaze administration. The information related to patient preference can be used for future development of alternative means of administration of anesthetics with understanding patients’ expectations and desires.”
Full text of the article, “Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler Flowmetry,” Anesthesia Progress, Vol. 68, No. 4, 2021, is now available at https://doi.org/10.2344/anpr-68-03-10
About Anesthesia Progress
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit: http://www.adsahome.org/.
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