RESUMO
Bupivacaine is a long-acting local anaesthetic that is widely used in medicine and dentistry. The duration and intensity of its sensory blockade in animal models is increased by its inclusion in complexes with cyclodextrins. The aim of the present study was to evaluate the anaesthetic efficacy of bupivacaine 2-hydroxypropyl-ß-cyclodextrin (HPßCD) inclusion complex for dental anaesthesia after inferior alveolar nerve block in rats. Thirty rats were each given an injection close to the mandibular foramen of 0.2ml of one of the following formulations: 0.5% bupivacaine alone; 0.5% bupivacaine with 1:200,000 epinephrine; and 0.5% bupivacaine-HPßCD inclusion complex (bupivacaine-HPßCD). The other sides were used as controls, with either 0.9% saline or anaesthetic-free HPßCD solution being injected. The onset, success, and duration of pulpal anaesthesia were assessed by electrical stimulation ("pulp tester") on inferior molars. Results were analysed using ANOVA (Tukey), log rank, and chi square tests (α=5%). There were no differences among the formulations in onset of anaesthesia (p=0.59) or between the bupivacaine plus epinephrine and bupivacaine plus HPßCD in duration of anaesthesia, but bupivacaine plus epinephrine gave significantly higher values than bupivacaine alone (p=0.007). Bupivacaine plus epinephrine was a better anaesthetic than bupivacaine alone (p=0.02), while Bupi-HPßCD gave intermediate results, and therefore did not differ significantly from the other 2 groups (p=0.18 with bupivacaine alone; and p=0.44 with bupivacaine plus epinephrine). The bupivacaine-HPßCD complex showed similar anaesthetic properties to those of bupivacaine with epinephrine.
Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Excipientes/administração & dosagem , Nervo Mandibular/efeitos dos fármacos , Bloqueio Nervoso/métodos , beta-Ciclodextrinas/administração & dosagem , 2-Hidroxipropil-beta-Ciclodextrina , Período de Recuperação da Anestesia , Animais , Polpa Dentária/efeitos dos fármacos , Polpa Dentária/inervação , Teste da Polpa Dentária/instrumentação , Estimulação Elétrica/instrumentação , Epinefrina/administração & dosagem , Injeções , Masculino , Modelos Animais , Dente Molar/efeitos dos fármacos , Dente Molar/inervação , Distribuição Aleatória , Ratos , Ratos Wistar , Fatores de Tempo , Vasoconstritores/administração & dosagemRESUMO
The main mandibular anesthesia techniques used are directed to the mandibular lingula and Gow-Gates, especially the former presents considerable surgical risks, including intravascular puncture, which is presented in 1520 percent of the cases. In this study, we applied this anesthetic technique to the inferior alveolar nerve via the retromolar triangle in 20 patients who were 4060 years old to evaluate its effectiveness, determine the latency time, and ascertain whether the anesthesia administered is sufficient to carry out the surgery and endodontics. The technique proved to be effective in 75 percent of the cases, measured and controlled with pre-vitalometer test at 5, 10, and 15 minutes. Because this technique is simple, minimally invasive,and involves low risk, it is recommended as an alternative to conventional mandibular anesthetic techniques in patients with blood dyscrasias and patients who are suspected to submit to arterial hypertension but require anesthesia with vasoconstrictor.
Las principales técnicas anestésicas mandibulares usadas son la dirigida a la língula mandibular y la Gow-Gates, especialmente la primera, la cual presenta un importante porcentaje de riesgos operatorios, destacándose la punción intravascular, la cual se presenta en un 15- 20 por ciento de los casos. En este estudio se aplicó esta técnica anestésica al nervio alveolar inferior vía trígono retromolar en 20 pacientes de 40 a 60 años de edad con el fin de evaluar su efectividad, determinar los tiempos de latencia y averiguar si la anestesia conseguida es suficiente para realizar trabajos de operatoria y endodoncia. La técnica resultó ser efectiva en el 75 por ciento de los casos, medida con vitalometría previa y controlada a los 5, 10 y 15 minutos. Esta técnica se recomienda como una alternativa a las técnicas anestésicas convencionales mandibulares en pacientes con discrasias y en pacientes que se sospeche que presenten hipertensión arterial y se requiera usar anestésico con vasoconstrictor; debido a que es una técnica sencilla, poco invasiva y de bajo riesgo.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Anestesia Dentária/métodos , Bloqueio Nervoso/métodos , Dente Molar/inervação , Nervo MandibularRESUMO
UNLABELLED: One of the most commonly used mandibular anesthesia techniques is the Spix technique, which is very useful in clinical practice, but is risky when the patient is a bearer of blood dyscrasias. OBJECTIVE: The aim of this study was to present an alternative to the Spix technique in order to achieve troncular anesthesia of the inferior alveolar nerve. To this purpose, an infiltrative technique was designed to anesthetize the inferior alveolar nerve via the retromolar triangle. STUDY DESIGN: This study included 40 patients with an average age of 23.65 years, 22 males and 18 females, who were previously evaluated with a vitalometer control, then subjected to the designed anesthetic technique. The effectiveness of the technique used to anesthetize the inferior alveolar nerve was evaluated by the results of tests using a vitalometer applied to a molar and a premolar on the anesthetized side after 5, 10 and 15 minutes. Moreover, the anesthesia was evaluated in mucosa innervated regions by the inferior alveolar, lingual and buccal nerves, and by having the patient relate the duration of the induced feeling of numbness. RESULTS: The technique proved to be effective in 72.5% of the cases, with a latency of 10 minutes and an average duration of the anesthetic effect for 141.125 minutes. Moreover, anesthesia was obtained in the mucosa innervated regions by the inferior alveolar nerve in 72.5% of the cases, by the buccal nerve in 27.5% and in the innervated areas by the lingual nerve in 55% of the cases. CONCLUSIONS: The proposed technique, even when it proved to be less effective than the Spix technique, can be seen as a lower risk alternative for patients carrying blood dyscrasias and being subjected to dental procedures in mandibular teeth.
Assuntos
Anestesia Dentária/métodos , Dente Pré-Molar , Transtornos da Coagulação Sanguínea/complicações , Nervo Mandibular , Dente Molar , Bloqueio Nervoso/métodos , Adulto , Idoso , Dente Pré-Molar/inervação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dente Molar/inervação , Fatores de TempoRESUMO
Presently study carried out an anatomical and morphometric analysis of the retromolar triangle and their relationships with the mandibular canal. Sixthy six adults mandibles were used without gender distinction, a sample of 120 retromolar triangles was identified and defined, each one of their sides was measured with a digital caliper and the number of present foramina in its area was counted. In an aleatory way 25 mandibles were selected to be traversely cut in the area of the retromolar triangle, and the distance was measured from the surface to mandibular canal. The area presented predominantly a triangular shape (80 percent), occupied by a variable number of little foramina, being more numerous those of small diameter. The medial side of the triangle was greatest (mean=15.91mm), while the anterior side was minor (mean=6.33mm). The area characteristics of the allow the anesthetic infiltration that diffuses until the mandibular canal.
En el presente estudio se realiza un análisis anatómico y morfométrico de la región del trígono retromolar y sus relaciones con el canal mandibular. Se utilizaron 66 mandíbulas de individuos adultos, sin distinción de sexos. Se identificó y delimitó una muestra de 120 trígonos, cada uno de sus lados fue medido con un caliper digital y se contabilizó el número de forámenes presentes en su área. De manera aleatoria fueron seleccionadas 25 mandíbulas para ser seccionadas transversalmente en la zona del trígonoretromolar y se midió la distancia de la superficie al canal mandibular. La zona presentó una forma mayoritariamente triangular (80 por ciento), ocupada por un número variable de forámenes, siendo más numerosos los de pequeño diámetro. El lado medial del trígono resultó ser el mayor (media=15,91mm), mientras que el menor fue el anterior (media= 6,33mm). Las características de la zona permiten la infiltración de una solución anestésica que difunda hasta el canal mandibular.