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Anesthetic efficacy. Paired statistical analysis showed significant statistical difference between each of the anesthetics; LE and MP (P = .0016), MP and KNS (P = .0143), and LE and KNS (P < .0001). KNS, Kovanaze; LE, 2% lidocaine with 1:100,000 epinephrine; MP, 3% mepivacaine plain.

Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.

Managing patients allergic to local anesthetics. Rule out common reactions misinterpreted as allergy, eg, syncope and tachycardia. Then establish that the nature of their reaction at least resembled a hypersensitivity reaction, eg, rash, pruritus, urticaria, or dyspnea. If the drug is known, choose another amide, free of vasopressor so no sulfites are present. Otherwise refer the patient to an allergist, for testing of sulfites and exemplary local anesthetics such as lidocaine, mepivacaine, and prilocaine. (Adapted from deShazo and Kemp.13)

Preference for traditional injections vs intranasal. Percentage (%) of participants who preferred traditional injections compared with intranasal administration when each test anesthetic was given. Paired statistical analysis showed no significant difference in preference comparing LE to MP (P = .8383), whereas there was a significant difference comparing LE to KNS (P = .0143) and MP to KNS (P = .0108). *P < .05. KNS, Kovanaze; LE, 2% lidocaine with 1:100,000 epinephrine; MP, 3% mepivacaine plain.

Incidence of maxillary central incisor pulpal anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80 readings), at each postinjection time interval, for the 2 anesthetic formulations. There were no significant differences (P < .05) between the solutions.

Incidence of maxillary first molar pulpal anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80 readings), at each postinjection time interval, for the 2 anesthetic formulations. There were no significant differences (P < .05) between the solutions.