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Increased Anesthesia Volume May Provide Longer Pain Relief During Dental Procedures

Anesthesia Progress – A typical cause of anxiety around dental visits is a fear of pain during a procedure. While many techniques and strategies exist to control the pain, some patients still report feeling a certain amount of pain, especially during more lengthy or complex procedures. One of the most common methods that dentists employ for pain control is using anesthesia to help numb the treatment area; however, anesthesia’s effectiveness can wear off before the procedure is complete, leaving the patient with no recourse for the pain until the procedure is over.

To examine the optimal dosage and clinical success of using anesthesia during dental procedures, researchers from private practice and the Ohio State University in Columbus recently published a study in the current issue of Anesthesia Progress. Given that failure rates of pupal anesthesia using 1.8 mL of 4% articaine with 1:100,000 epinephrine have been reported to be up 22%, lead author Alexandra Woo, DMD, MS, and colleagues aimed to evaluate “whether a 3.6-mL volume of articaine would result in lower failure rates.”

A total of 118 healthy patients (52 male, 66 female), with an average age of 27 years, were assessed “to compare the peak incidence of success, onset, and incidence of pulpal anesthesia from 2 to 68 minutes in maxillary first molars following a buccal infiltration of 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine.” Patients were randomized into two groups and underwent two instances of receiving anesthesia spaced two weeks apart. Each patient received the 1.8- and 3.6-mL doses at the first appointment and then the opposite amount at the second to compare the results.

Woo et al. report that they found no statistical significance for the anesthetic success, which occurred between 14 and 18 minutes, for either volume. This was also true of the onset times (4.5 minutes for 1.8 mL; 4.5 for 3.4 mL). The significance occurred in the incidence of anesthesia at minute 48. The researchers found a greater decline in the incidence for the 1.8-mL volume from 48 to 68 minutes. For both the 1.8-mL and 3.4-mL volumes, the incidence began to decline at about 30 minutes, with the greatest decline happening at 48 minutes. However, 78% of patients had a higher incidence rate of pulpal anesthesia, from 48 to 68 minutes. Neither volume was successful at providing anesthesia for all subjects for 60 minutes.

This study shows that increasing the volume of anesthesia from 1.8 to 3.4 mL for lengthy dental procedures provided a longer pain control duration in procedures lasting more than 48 minutes. However, it also highlighted the need for additional action in administering additional anesthesia for longer dental procedures to ensure optimal patient comfort. Woo and colleagues state that anesthesia “reinjection could be a clinical strategy to ensure adequate anesthesia in the maxilla for procedures lasting 60 minutes or longer.”

Full text of the article, “Success of Pulpal Anesthesia Following Buccal Infiltration of the Maxillary First Molar With 1.8 mL and 3.6 mL of 4% Articaine With 1:100,000 Epinephrine: A Prospective, Randomized Crossover Study,” Anesthesia Progress, Vol. 70, No. 3, 2023, is now available at https://doi.org/10.2344/anpr-70-03-01

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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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