AIM: To identify whether articaine or lidocaine is the most appropriate local anaesthetic solution for teeth with irreversible pulpitis undergoing root canal treatment.
DATA SOURCE: The protocol of this umbrella review is registered in the PROSPERO database (CRD42019137624). PubMed, EBSCHO host and Scopus databases were searched until June 2019.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Systematic reviews published in English comparing the effectiveness of local anaesthesia following administration of articaine or lidocaine in patients undergoing root canal treatment of teeth diagnosed with irreversible pulpitis were included. Two independent reviewers selected the studies and carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer.
STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of the included reviews was appraised by two independent reviewers using the AMSTAR tool (a measurement tool to assess systematic reviews). Each of the 11 AMSTAR items was given a score of 1 if the specific criterion was met, or 0 if the criterion was not met or the information was unclear.
RESULTS: Five systematic reviews with meta-analyses were included. The AMSTAR score for the reviews ranged from 8 to 11, out of a maximum score of 11, and all reviews were categorized as 'high' quality. Two reviews scored 0 for item 8 in AMSTAR because the scientific quality of the clinical trials included in these reviews was not used in the formulation of the conclusions.
LIMITATIONS: Systematic reviews published only in the English language were included. Only a small number of studies were available to assess pain intensity during the injection phase, the time until the onset of anaesthesia and the occurrence of adverse events.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Articaine is more effective than lidocaine for local anaesthesia of teeth with irreversible pulpitis undergoing root canal treatment. There is limited evidence that injection of articaine is less painful, has more rapid onset and has fewer adverse events compared with lidocaine.
METHODOLOGY: The study was designed as a double-blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre-incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post-operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24-h post-operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed.
RESULTS: Ninety-four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8 min (SD = 56.5), and mean length of hospital stay was 4.7 days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post-operative period (post-operative 0.5 h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20 h starting from 4 h post-operatively. Pre-incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post-operative pain score difference was statistically significant at 2 h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post-operative 1 h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2 h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4 h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6 h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12 h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24 h duration was lower in the diclofenac group as compared to bupivacaine group [13.8 mg (SD = 24.9) vs. 36.2 mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p
DESIGN: Retrospective cohort study.
SETTING: Operation theater with postoperative inpatient follow-up.
PATIENTS: The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.
INTERVENTIONS: Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.
MEASUREMENTS: The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.
MAIN RESULTS: One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.
CONCLUSION: Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.
MATERIALS AND METHODS: A randomised control clinical trial was conducted at the Central Surgery Installation and Hasan Sadikin General Hospital Bandung and Dr. Mohammad Husein Hospital Palembang from December 2022 to June 2023. A total of 40 participants were divided into two groups using block randomisation. Group I receives bupivacaine 0.25% and clonidine 2 μg/kg, and group II receives bupivacaine 0.25% and dexamethasone 8 mg. The plasma cortisol levels of the patient will be assessed at (T0, T1 and T2). All the patient were intubated under general anesthaesia and received the drug for scalp block based on the group being randomised. Haemodynamic monitoring was carried out.
RESULTS: There was a significant difference in administering bupivacaine 0.25% and clonidine 2μg/kg compared to administering bupivacaine 0.25% and dexamethasone 8 mg/kg as analgesia for scalp block in tumour craniotomy patients on cortisol levels at 12 hours post-operatively (T1) (p=0.048) and 24 hours post-surgery (T2) (p=0.027), while post-intubation cortisol levels (T0) found no significant difference (p=0.756). There is a significant difference in Numeric Rating Scale (NRS) at post-intubation (T0) (p=0.003), 12 hours post-operatively (T1) (p=0.002) and 24 hours post-surgery (T2) (p=0.004), There were no postprocedure scalp block side effects in both groups.
CONCLUSION: The study found that scalp block with 0.25% bupivacaine and 2μg/kg clonidine is more effective in reducing NRS scores and cortisol levels compared bupivacaine 0.25% and dexamethasone 8mg in tumour craniotomy patients.
METHODS: Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
RESULTS: Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.
CONCLUSIONS: GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.
Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA.
Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: -0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle.
Conclusion: The 1 mL syringe with original 26G needle shows the best combination.