Editorial Type:
Article Category: Other
 | 
Online Publication Date: Jan 01, 2006

Elevation of a Periosteal Flap with Irrigation of the Bone for Minor Oral Surgery Reduces the Duration of Action of Infiltration Anesthesia

DDS, PhD,
DDS,
DDS,
DDS, and
DDS, PhD
Page Range: 8 – 12
DOI: 10.2344/0003-3006(2006)53[8:EOAPFW]2.0.CO;2
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Abstract

The aim of this study is to assess the difference in duration of action after infiltration anesthesia when elevation of a periosteal flap (EPF) was accomplished with water or saline irrigation versus nonelevation of a periosteal flap (NEPF). The 57 patients in this study were under conscious sedation. A long treatment time of more than 1 hour was used. Instances where peripheral nerve block or opioids were administered and infiltration anesthesia over 2 fields were excluded before the study. Patients were included in either an EPF group (n = 29) or an NEPF group (n = 28). Statistically significant differences were detected in the initial dose of anesthetic (EPF: 4.3 ± 1.4 mL, NEPF: 1.8 ± 0.9 mL), the time until initial supplemental anesthesia (EPF: 38 ± 26 minutes, NEPF: 65 ± 27 minutes), and the frequency of anesthesia administration (EPF: 2.5 ± 1.2 times, NEPF: 1.3 ± 0.7 times). These results suggest that the duration of anesthesia action in EPF decreases to half compared with NEPF, even if the anesthetic was infiltrated in double the amount. Although supplemental anesthesia is required frequently in EPF, it is not efficacious. We speculated that the residual anesthetics in tissue were washed out by irrigation and hemorrhage and that supplemental anesthesia became ineffective because of leakage from the opened flap. Elevation of a periosteal flap reduces the effect of infiltration anesthetics.

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Copyright: © 2005 by the American Dental Society of Anesthesiology
Figure 1.
Figure 1.

The time (minutes) until initial supplemental infiltration anesthesia. During the period of the initial dose of infiltration anesthetics, there was a significant difference (P = .0000004) between elevation of a periosteal flap (EPF) (4.3 ± 1.4 mL, 2–7.2 mL) and nonelevation of a periosteal flap (NEPF) (1.8 ± 0.9 mL, 0.3–4.4 mL). During the period before initial supplemental infiltration anesthesia, there was a significant difference (P = .0015) between EPF (38 ± 26 minutes, 10–100 minutes) and NEPF (65 ± 27 minutes, 15–120 minutes).


Figure 2.
Figure 2.

The frequency of infiltration anesthesia. There was significant difference (P = .0001) between elevation of a periosteal flap (2.5 ± 1.2 times, 1–5 times) and nonelevation of a periosteal flap (1.3 ± 0.7 times, 1–4 times).


Figure 3.
Figure 3.

Ratio differences in the frequency of anesthesia infiltration. There was a significant difference (P = .00001) between elevation of a periosteal flap (6 : 23) and nonelevation of a periosteal flap (23 : 5).


Figure 4.
Figure 4.

The mean interval of multiple anesthetic infiltration was 25 ± 12 minutes (5–50 minutes) in 23 cases of elevation of a periosteal flap and 37 ± 16 minutes (15–55 minutes) in the 5 cases of nonelevation of a periosteal flap (NEPF). However, the small sample size in the NEPF group prevented a significant difference from being detected.


Contributor Notes

Address correspondence to Shinya Yamazaki, Department of Dental Anesthesiology, Dental School, Ohu University, 31-1 Misumido, Tomita, Koriyama, Fukushima, 963-8611 Japan; zakiyama@ops.dti.ne.jp.
Received: Sep 03, 2004
Accepted: Mar 28, 2005