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Anna Taddio - One of the best experts on this subject based on the ideXlab platform.
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pharmacological and combined interventions to reduce vaccine Injection Pain in children and adults systematic review and meta analysis
The Clinical Journal of Pain, 2015Co-Authors: Vibhuti Shah, Anna Taddio, Meghan C Mcmurtry, Scott A Halperin, Melanie Noel, Rebecca Pillai Riddell, Christine T ChambersAbstract:Background: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine Injection Pain in individuals across the lifespan.
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A randomized trial of rotavirus vaccine versus sucrose solution for vaccine Injection Pain.
Vaccine, 2015Co-Authors: Anna Taddio, Daniel Flanders, Eitan Weinberg, Charmy Vyas, Andrew F. Ilersich, Supriya Lamba, Carol McnairAbstract:Abstract Objective Sucrose solutions are analgesic in infants. Oral rotavirus vaccine contains sucrose, however, it is not known if it possesses analgesic properties. The objective was to compare the analgesic effectiveness of rotavirus vaccine to sucrose solution when administered prior to injectable vaccines. Methods Infants 2–4 months of age receiving oral rotavirus vaccine and two separate injectable vaccines on the same day were randomized to rotavirus vaccine (Rotarix™) first followed by the injectable vaccines and sucrose (Tootsweet™) afterwards, or vice versa. Pain was assessed by blinded raters using the Numerical Rating Scale (NRS, range 0–10) (parents, clinicians), or Modified Behavioural Pain Scale (MBPS, range 0–10) and cry duration (observers). Data were analyzed using t -tests or χ 2 -tests; Bonferroni correction was applied to correct for multiple comparisons, as appropriate. Results Altogether, 120 infants participated: 60 were randomized to rotavirus vaccine first. Groups did not differ in demographics, including; age ( p = 0.448) and sex ( p = 0.464). The mean Pain score (standard deviation) for both vaccine Injections did not differ between infants given rotavirus vaccine first versus sucrose solution first: observer MBPS, parent NRS and clinician NRS scores were 7.4 (1.6) vs. 7.7 (1.6), 4.9 (2.1) vs. 5.8 (2.1), and 4.2 (2.1) vs. 4.6 (2.2), respectively. Similarly, there was no difference between groups in cry duration. Conclusion Rotavirus vaccine did not differ from sucrose solution in reducing Injection-induced Pain. Based on the findings, it is recommended that rotavirus vaccine be administered prior to injectable vaccines in infants aged 2 and 4 months.
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systematic review and meta analysis of the effect of warming local anesthetics on Injection Pain
Annals of Emergency Medicine, 2011Co-Authors: Maryellen Hogan, Sondra Vandervaart, Kumar Perampaladas, Marcio Machado, Thomas R Einarson, Anna TaddioAbstract:Study objective Local anesthetics are the main class of analgesics used for Pain management during laceration repair and other minor surgeries; however, they are administered by Injection, which is Painful. Warming local anesthetics has been proposed as a cost-free intervention that reduces Injection Pain. A systematic review of the effectiveness of this technique has not yet been undertaken. We determine the effectiveness of warming local anesthetics to reduce Pain in adults and children undergoing local anesthetic infiltration into intradermal or subcutaneous tissue. Methods We used published articles from MEDLINE (1950 to June 2010), EMBASE (1980 to June 2010), CINAHL (1982 to June 2010), the Cochrane Library (second quarter 2010), International Pharmaceutical Abstracts (1970 to June 2010), and ProQuest Dissertations and Theses database (1938 to June 2010). We included studies with randomized or pseudorandomized designs and healthy subjects or patients receiving subcutaneous or intradermal Injection of local anesthetics that were warmed (body temperature) or not (room temperature). Studies of regional anesthesia and intraarticular, spinal, or periorbital administration of local anesthetics were excluded. Data were extracted onto predesigned forms and verified by 2 reviewers. Quality was assessed with the Cochrane risk of bias tool. The primary outcome was self-reported Pain as assessed by a visual analog or numeric rating scale. Data were combined with mean differences with 95% confidence intervals (CIs) by using a random-effects model. Results Twenty-nine studies were retrieved for close examination and 19 studies met inclusion criteria. A total of 18 studies with 831 patients could be included in a meta-analysis. Seventeen studies had an unclear risk of bias and 1 had a high risk of bias. A mean difference of −11 mm (95% CI −14 to −7 mm) on a 100-mm scale was found in favor of warming local anesthetics. Subgroup analysis of 8 studies investigating the effect of warming on buffered local anesthetics yielded similar results: −7 mm (95% CI −12 to −3 mm). Conclusion Warming local anesthetics leads to less Pain during Injection and therefore should be done before administration.
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a systematic review of measures for reducing Injection Pain during adult immunization
Vaccine, 2010Co-Authors: Maryellen Hogan, Andrew Kikuta, Anna TaddioAbstract:Abstract Objective To evaluate the effectiveness of different Pain-relieving interventions to reduce Pain from immunization in adults. Data sources MEDLINE (1950 to October Week 3 2008) PsycINFO (1967 to December Week 1 2008), CINAHL (1982 to October Week 4 2008), EMBASE (1980 to 2008 Week 43) and the Cochrane Central Register of Controlled Trials (3rd Quarter 2008). Review methods Databases were searched for trials of pharmacological, behavioural, physical or operator-dependant techniques to reduce Pain from immunization in adults. The primary outcome was Pain as assessed by visual analogue scale or other numeric rating scale. Results Six studies representing 853 participants were identified. One study evaluating pharmacological interventions (lidocaine–prilocaine) found them to be effective in reducing Pain from immunization. Similarly, two studies evaluating physical Pain relieving techniques, either skin cooling interventions (Fluori-Methane ® ) or tactile stimulation (manual pressure at the site of Injection) found them to reduce Pain. One study of jet injectors found them to be more Painful than conventional needle and syringe. Neither freezing needles nor warming vaccines was found to be effective in reducing Pain. No studies investigated psychological interventions or oral analgesics (acetaminophen and ibuprofen). Conclusion There was limited evidence to support the use of lidocaine–prilocaine, Fluori-Methane ® and manual pressure for reducing immunization Pain in adults. There was limited evidence of more Pain with jet injectors compared to needle and syringe. Due to limited data, we recommend further investigation of methods to reduce immunization Pain in adults, primarily psychological and physical techniques.
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effectiveness and tolerability of pharmacologic and combined interventions for reducing Injection Pain during routine childhood immunizations systematic review and meta analyses
Clinical Therapeutics, 2009Co-Authors: Anna Taddio, Vibhuti Shah, Michael J RiederAbstract:Abstract Background : Immunization is the most common cause of iatrogenic Pain in childhood. Despite the availability of various analgesics to manage vaccine Injection Pain, they have not been incorporated into clinical practice. To date, no systematic review has been published on the effectiveness of pharmacologic and combined interventions for reducing Injection Pain. Objectives : The objectives of this article were to assess the effectiveness and tolerability of various pharmacologic and combined interventions for reducing the Pain experienced by children during immunization. Methods : MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials (RCTs) and quasi-RCTs pertaining to pharmacologic and combined interventions to reduce Injection Pain in children 0 to 18 years of age using validated child self-reported Pain or observer-reported assessments of child Pain and distress. We included trials that (1) investigated the effects of pharmacologic interventions (ie, topical local anesthetics, sweet-tasting solutions, vapocoolants, and oral analgesics [acetaminophen or ibuprofen]); (2) compared 2 different analgesic interventions; and (3) evaluated combinations of >2 analgesic interventions, including breastfeeding. Meta-analyses were performed using a fixed-effects model. Results : Thirty-two studies, involving 3856 infants and children 2 weeks to 15 years of age, were included in this systematic review; 23 of these trials were included in meta-analyses. Ten trials, including 1156 infants and children, evaluated topical local anesthetics. In a meta-analysis of 2 trials, including 276 children, child self-reported Pain ratings were lower in children who received topical local anesthetics than in those who received a placebo. The standardized mean difference (SMD) was −0.25 (95% CI, −0.49 to −0.01; P = 0.04). The use of topical local anesthetics was associated with less Pain than was placebo in 4 trials (527 infants) based on the difference between Modified Behavioral Pain Scale scores (range, 0–10) before and after vaccination: the weighted mean difference (WMD) was −0.79 (95% CI, −1.10 to −0.48; P P = 0.001). Observer-rated Pain, using visual analog scale (VAS) scores (range, 0–100 mm), was significantly lower (WMD, −16.56 mm; 95% CI, −22.11 to −11.01; P P -3), was 3.7 (95% CI, 2.5 to 7.7) from 1 study. Eleven trials (1452 infants and children) evaluated sweet-tasting solutions. In a meta-analysis of 6 studies (665 infants), administration of sucrose with or without non-nutritive sucking (NNS; use of a pacifier) was associated with less Pain than no intervention or sterile water with or without NNS; the SMD was −0.56 (95% CI, −0.72 to −0.40; P P P 3), was 1.4 (95% CI, 1.0 to 2.5). In 3 trials that evaluated sweet-tasting solutions longitudinally, administration of sucrose or glucose (vs sterile water, with or without NNS) was associated with reduced Pain based on cry duration or the University of Wisconsin Children's Hospital Pain Scale (all, P P = 0.04); significant heterogeneity was reported for this outcome (χ 2 = 5.51; P = 0.02; I 2 = 82%). In 2 studies (117 children), no significant difference was found between vapocoolants and typical care (no treatment) based on child self-reports; significant heterogeneity was reported for this outcome (χ 2 = 9.89; P = 0.02; I 2 = 90%). None of the studies identified in the literature search evaluated oral analgesics (acetaminophen or ibuprofen). Four studies (318 infants and children) compared 2 different analgesic interventions; there was insufficient evidence to suggest superiority of 1 intervention over another. Combinations of >-2 analgesic interventions were more effective than the individual interventions used alone. Child self-reported Pain ratings were combined for 4 studies (350 children); the SMD was −0.52 (95% CI, −0.73 to −0.30; P = 0.001). Data on cry duration were pooled for 3 studies (229 infants and children); the WMD was −18.87 seconds (95% CI, −32.05 to −5.69; P = 0.005). Parent-rated child Pain (VAS) scores were combined for 3 studies (365 infants and children); the WMD was −15.66 mm (95% CI, −19.74 to −11.57; P P P P P Conclusion : Topical local anesthetics, sweet-tasting solutions, and combined analgesic interventions, including breastfeeding, were associated with reduced Pain during childhood immunizations and should be recommended for use in clinical practice.
Vibhuti Shah - One of the best experts on this subject based on the ideXlab platform.
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pharmacological and combined interventions to reduce vaccine Injection Pain in children and adults systematic review and meta analysis
The Clinical Journal of Pain, 2015Co-Authors: Vibhuti Shah, Anna Taddio, Meghan C Mcmurtry, Scott A Halperin, Melanie Noel, Rebecca Pillai Riddell, Christine T ChambersAbstract:Background: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine Injection Pain in individuals across the lifespan.
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effectiveness and tolerability of pharmacologic and combined interventions for reducing Injection Pain during routine childhood immunizations systematic review and meta analyses
Clinical Therapeutics, 2009Co-Authors: Anna Taddio, Vibhuti Shah, Michael J RiederAbstract:Abstract Background : Immunization is the most common cause of iatrogenic Pain in childhood. Despite the availability of various analgesics to manage vaccine Injection Pain, they have not been incorporated into clinical practice. To date, no systematic review has been published on the effectiveness of pharmacologic and combined interventions for reducing Injection Pain. Objectives : The objectives of this article were to assess the effectiveness and tolerability of various pharmacologic and combined interventions for reducing the Pain experienced by children during immunization. Methods : MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials (RCTs) and quasi-RCTs pertaining to pharmacologic and combined interventions to reduce Injection Pain in children 0 to 18 years of age using validated child self-reported Pain or observer-reported assessments of child Pain and distress. We included trials that (1) investigated the effects of pharmacologic interventions (ie, topical local anesthetics, sweet-tasting solutions, vapocoolants, and oral analgesics [acetaminophen or ibuprofen]); (2) compared 2 different analgesic interventions; and (3) evaluated combinations of >2 analgesic interventions, including breastfeeding. Meta-analyses were performed using a fixed-effects model. Results : Thirty-two studies, involving 3856 infants and children 2 weeks to 15 years of age, were included in this systematic review; 23 of these trials were included in meta-analyses. Ten trials, including 1156 infants and children, evaluated topical local anesthetics. In a meta-analysis of 2 trials, including 276 children, child self-reported Pain ratings were lower in children who received topical local anesthetics than in those who received a placebo. The standardized mean difference (SMD) was −0.25 (95% CI, −0.49 to −0.01; P = 0.04). The use of topical local anesthetics was associated with less Pain than was placebo in 4 trials (527 infants) based on the difference between Modified Behavioral Pain Scale scores (range, 0–10) before and after vaccination: the weighted mean difference (WMD) was −0.79 (95% CI, −1.10 to −0.48; P P = 0.001). Observer-rated Pain, using visual analog scale (VAS) scores (range, 0–100 mm), was significantly lower (WMD, −16.56 mm; 95% CI, −22.11 to −11.01; P P -3), was 3.7 (95% CI, 2.5 to 7.7) from 1 study. Eleven trials (1452 infants and children) evaluated sweet-tasting solutions. In a meta-analysis of 6 studies (665 infants), administration of sucrose with or without non-nutritive sucking (NNS; use of a pacifier) was associated with less Pain than no intervention or sterile water with or without NNS; the SMD was −0.56 (95% CI, −0.72 to −0.40; P P P 3), was 1.4 (95% CI, 1.0 to 2.5). In 3 trials that evaluated sweet-tasting solutions longitudinally, administration of sucrose or glucose (vs sterile water, with or without NNS) was associated with reduced Pain based on cry duration or the University of Wisconsin Children's Hospital Pain Scale (all, P P = 0.04); significant heterogeneity was reported for this outcome (χ 2 = 5.51; P = 0.02; I 2 = 82%). In 2 studies (117 children), no significant difference was found between vapocoolants and typical care (no treatment) based on child self-reports; significant heterogeneity was reported for this outcome (χ 2 = 9.89; P = 0.02; I 2 = 90%). None of the studies identified in the literature search evaluated oral analgesics (acetaminophen or ibuprofen). Four studies (318 infants and children) compared 2 different analgesic interventions; there was insufficient evidence to suggest superiority of 1 intervention over another. Combinations of >-2 analgesic interventions were more effective than the individual interventions used alone. Child self-reported Pain ratings were combined for 4 studies (350 children); the SMD was −0.52 (95% CI, −0.73 to −0.30; P = 0.001). Data on cry duration were pooled for 3 studies (229 infants and children); the WMD was −18.87 seconds (95% CI, −32.05 to −5.69; P = 0.005). Parent-rated child Pain (VAS) scores were combined for 3 studies (365 infants and children); the WMD was −15.66 mm (95% CI, −19.74 to −11.57; P P P P P Conclusion : Topical local anesthetics, sweet-tasting solutions, and combined analgesic interventions, including breastfeeding, were associated with reduced Pain during childhood immunizations and should be recommended for use in clinical practice.
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physical interventions and Injection techniques for reducing Injection Pain during routine childhood immunizations systematic review of randomized controlled trials and quasi randomized controlled trials
Clinical Therapeutics, 2009Co-Authors: Anna Taddio, Vibhuti Shah, Andrew Kikuta, Lane A Ilersich, Moshe IppAbstract:Background: Vaccine Injections are the most common reason for iatrogenic Pain in childhood. With the steadily increasing number of recommended vaccinations, there has been a concomitant increase in concern regarding the adequacy of Pain management. Physical interventions and Injection techniques that minimize Pain during vaccine Injection offer an advantage over other techniques because they can be easily incorporated into clinical practice without added cost or time. Their effectiveness, however, has not previously been studied using a systematic approach. Objective: The purpose of this review was to determine the effectiveness of physical interventions and Injection techniques for reducing Pain during vaccine Injection in children. Methods: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched to identify randomized controlled trials (RCTs) and quasi-RCTs that determined the effect of physical interventions and Injection techniques on Pain during Injection of vaccines in children 0 to 18 years of age, using validated child self-reported Pain or assessments of child distress or Pain made by others (parent, nurse, physician, observer). We sought to determine the effects of: (1) different formulations of the same vaccine; (2) position of the child during Injection; (3) intramuscular versus subcutaneous Injection; (4) cooling of the skin at the Injection site with ice before Injection; (5) stroking the skin or applying pressure close to the Injection site before and during Injection; (6) order of vaccine Injection when 2 vaccines were administered sequentially; (7) simultaneous versus sequential Injection of 2 vaccines; (8) vaccine temperature; (9) aspiration before Injection; (10) anatomic location of Injection; (11) aspects of the needle (gauge, length, angle of insertion, speed of Injection); and (12) combinations of these interventions. All meta-analyses were performed using a fixed-effects model. Results: Nineteen RCTs involving 2814 infants and children (0–18 years of age) were included in the systematic review. One study included children ≥16 years and adults (n = 150). Interventions with positive findings are summarized here. In 2 trials that used child self-reports of Pain during administration of measles-mumps-rubella vaccine (total, 680 children with complete data), the Priorix vaccine caused less Pain than the M-M-RII vaccine (standardized mean difference [SMD], −0.66; 95% CI, −0.81 to −0.50; P < 0.001). In 3 trials (404 children), the number needed to treat (NNT) with Priorix to prevent 1 child from crying was 3.2 (95% CI, 2.6–4.2). In 4 trials (281 infants and children), sitting children up or having parents hold infants appeared to cause less Pain than the supine position, but the difference was not statistically significant; however, significant heterogeneity was found among the studies, and a qualitative approach was used for data analysis. A benefit was observed for 3 of the 4 studies; the SMD ranged from −0.4 to −0.8 (P < 0.05 for all analyses). The negative findings observed for the remaining study may have been the result of methodologic heterogeneity. Stroking the skin close to the Injection site before and during Injection reduced Pain in 1 trial (66 children; SMD, −0.53; P = 0.03). One study (120 children) found that when diphtheria-polio-tetanus-acellular pertussis-Haemophilus influenzae type b (DPTaP-Hib; Pentacel) and pneumococcus (Prevnar) were injected sequentially during the same office visit, observer- and parent-reported Pain scores were lower when DPTaP-Hib was injected first (SMD, −0.40 and −0.57, respectively; P ≤ 0.03). In 1 study (113 infants) comparing rapid intramuscular Injection without aspiration and slow intramuscular Injection with aspiration, the rapid Injection without aspiration was associated with less Pain (SMD, −0.62 to −0.97 for parent, nurse, physician, and observer behavioral Pain ratings; all, P < 0.05). The NNT to prevent 1 infant from crying was 2.5 (95% CI, 1.8–4.3). Conclusions: Pain during immunization can be decreased by: (1) injecting the least Painful formulation of a vaccine; (2) having the child sit up (or holding an infant); (3) stroking the skin or applying pressure close to the Injection site before and during Injection; (4) injecting the least Painful vaccine first when 2 vaccines are being administered sequentially during a single office visit; and (5) performing a rapid intramuscular Injection without aspiration.
Mike Beck - One of the best experts on this subject based on the ideXlab platform.
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is eye color related to dental Injection Pain a prospective randomized single blind study
Journal of Endodontics, 2018Co-Authors: Jason Hyde, John Nusstein, Al Reader, Sara Fowler, Melissa Drum, Mike BeckAbstract:Abstract Introduction Recent studies have investigated the relationship between Pain perception and specific phenotypes such as red hair color and various eye colors. Further investigations into biomarkers as they relate to Pain could be useful in understanding underlying genetic components involved in these pathways. Additionally, it would be clinically useful to determine if a patient would be more likely to experience Pain during dental treatment based on eye color. The purpose of this study was to investigate a link between eye color and perceived Injection Pain in healthy, asymptomatic white women. Methods Three hundred healthy, adult, white female patients were included, 133 with dark eyes and 167 with light eyes. Dental anxiety was assessed with the Corah Dental Anxiety Scale. Subjects with their eye color masked by dark glasses received a right maxillary lateral incisor infiltration of 1 cartridge of 2% lidocaine with 1:100,000 epinephrine. Patients rated their Injection Pain on a 170-mm Heft-Parker visual analog scale. Photographs of the subjects' eyes were taken after the infiltrations and categorized into dark- and light-eyed groups by 3 independent observers. Comparisons for Injection Pain were analyzed using analysis of variance and the Tukey-Kramer test. Results No significant differences were found for Pain of Injection between dark- or light-eyed subjects. Conclusions Eye color was not shown to be a predictor for Injection Pain in white women. Therefore, eye color would not be clinically useful in determining if a patient would be more likely to experience Pain during dental treatment.
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effect of buffered 4 lidocaine on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis a prospective randomized double blind study
Journal of Endodontics, 2015Co-Authors: Jared Schellenberg, John Nusstein, Al Reader, Sara Fowler, Melissa Drum, Mike BeckAbstract:Abstract Introduction Medical studies have suggested that buffering local anesthetic may increase the ability to achieve anesthesia. The purpose of this study was to determine the effect of 4% buffered lidocaine on the anesthetic success of the inferior alveolar nerve (IAN) block in patients experiencing symptomatic irreversible pulpitis. Methods One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received a conventional IAN block using either 2.8 mL 4% lidocaine with 1:100,000 epinephrine or 2.8 mL 4% lidocaine with 1:100,000 epinephrine buffered with sodium bicarbonate in a double-blind manner. For the buffered solution, each cartridge was buffered with 8.4% sodium bicarbonate using the OnPharma (Los Gatos, CA) system to produce a final concentration of 0.18 mEq/mL sodium bicarbonate. Fifteen minutes after administration of the IAN block, profound lip numbness was confirmed, and endodontic access was initiated. Success was defined as no or mild Pain (≤54 mm on a 170-mm visual analog scale) on access or instrumentation of the root canal. Results The success rate for the IAN block was 32% for the buffered group and 40% for the nonbuffered group, with no significant difference ( P = .4047) between the groups. Injection Pain ratings for the IAN block were not significantly ( P = .9080) different between the 2 formulations. Conclusions For mandibular posterior teeth, a 4% buffered lidocaine formulation did not result in a statistically significant increase in the success rate or a decrease in Injection Pain of the IAN block in patients with symptomatic irreversible pulpitis.
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does the combination of 3 mepivacaine plain plus 2 lidocaine with epinephrine improve anesthesia and reduce the Pain of anesthetic Injection for the inferior alveolar nerve block a prospective randomized double blind study
Journal of Endodontics, 2014Co-Authors: Emily Lammers, John Nusstein, Al Reader, Melissa Drum, Mike Beck, Sara FowlerAbstract:Abstract Introduction In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the Pain of Injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection Pain was also studied. Methods One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the Pain of Injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes. Results Success was not significantly different ( P > .05) between the 2 combinations. No statistical differences in Injection Pain or onset times were found. Conclusions The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of Injection Pain, onset time, and pulpal anesthetic success for the IAN block.
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Injection Pain of the inferior alveolar nerve block in patients with irreversible pulpitis
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2007Co-Authors: Melissa Mccartney, Al Reader, Mike BeckAbstract:Objective The purpose of this retrospective analysis was to determine the Pain associated with needle insertion, placement, and solution deposition for the conventional inferior alveolar nerve (IAN) block in patients with irreversible pulpitis. Study design One hundred two emergency patients with irreversible pulpitis received IAN block Injections using 2% lidocaine with 1:100,000 epinephrine. The patients recorded Pain of the 3 Injection stages on a Heft-Parker visual analog scale (VAS). Results Moderate-to-severe Pain may occur 57% to 89% of the time with the IAN block. Needle placement was significantly more Painful than needle insertion for men and significantly more Painful than either insertion or deposition for women (P .05). Deposition of 0.2 to 0.4 mL anesthetic during placement did not significantly reduce placement Pain for either gender (P = .753). Conclusion In conclusion, 57% to 89% of patients presenting with irreversible pulpitis have the potential for moderate to severe Pain with the IAN block.
Sara Fowler - One of the best experts on this subject based on the ideXlab platform.
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is eye color related to dental Injection Pain a prospective randomized single blind study
Journal of Endodontics, 2018Co-Authors: Jason Hyde, John Nusstein, Al Reader, Sara Fowler, Melissa Drum, Mike BeckAbstract:Abstract Introduction Recent studies have investigated the relationship between Pain perception and specific phenotypes such as red hair color and various eye colors. Further investigations into biomarkers as they relate to Pain could be useful in understanding underlying genetic components involved in these pathways. Additionally, it would be clinically useful to determine if a patient would be more likely to experience Pain during dental treatment based on eye color. The purpose of this study was to investigate a link between eye color and perceived Injection Pain in healthy, asymptomatic white women. Methods Three hundred healthy, adult, white female patients were included, 133 with dark eyes and 167 with light eyes. Dental anxiety was assessed with the Corah Dental Anxiety Scale. Subjects with their eye color masked by dark glasses received a right maxillary lateral incisor infiltration of 1 cartridge of 2% lidocaine with 1:100,000 epinephrine. Patients rated their Injection Pain on a 170-mm Heft-Parker visual analog scale. Photographs of the subjects' eyes were taken after the infiltrations and categorized into dark- and light-eyed groups by 3 independent observers. Comparisons for Injection Pain were analyzed using analysis of variance and the Tukey-Kramer test. Results No significant differences were found for Pain of Injection between dark- or light-eyed subjects. Conclusions Eye color was not shown to be a predictor for Injection Pain in white women. Therefore, eye color would not be clinically useful in determining if a patient would be more likely to experience Pain during dental treatment.
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effect of buffered 4 lidocaine on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis a prospective randomized double blind study
Journal of Endodontics, 2015Co-Authors: Jared Schellenberg, John Nusstein, Al Reader, Sara Fowler, Melissa Drum, Mike BeckAbstract:Abstract Introduction Medical studies have suggested that buffering local anesthetic may increase the ability to achieve anesthesia. The purpose of this study was to determine the effect of 4% buffered lidocaine on the anesthetic success of the inferior alveolar nerve (IAN) block in patients experiencing symptomatic irreversible pulpitis. Methods One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received a conventional IAN block using either 2.8 mL 4% lidocaine with 1:100,000 epinephrine or 2.8 mL 4% lidocaine with 1:100,000 epinephrine buffered with sodium bicarbonate in a double-blind manner. For the buffered solution, each cartridge was buffered with 8.4% sodium bicarbonate using the OnPharma (Los Gatos, CA) system to produce a final concentration of 0.18 mEq/mL sodium bicarbonate. Fifteen minutes after administration of the IAN block, profound lip numbness was confirmed, and endodontic access was initiated. Success was defined as no or mild Pain (≤54 mm on a 170-mm visual analog scale) on access or instrumentation of the root canal. Results The success rate for the IAN block was 32% for the buffered group and 40% for the nonbuffered group, with no significant difference ( P = .4047) between the groups. Injection Pain ratings for the IAN block were not significantly ( P = .9080) different between the 2 formulations. Conclusions For mandibular posterior teeth, a 4% buffered lidocaine formulation did not result in a statistically significant increase in the success rate or a decrease in Injection Pain of the IAN block in patients with symptomatic irreversible pulpitis.
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does the combination of 3 mepivacaine plain plus 2 lidocaine with epinephrine improve anesthesia and reduce the Pain of anesthetic Injection for the inferior alveolar nerve block a prospective randomized double blind study
Journal of Endodontics, 2014Co-Authors: Emily Lammers, John Nusstein, Al Reader, Melissa Drum, Mike Beck, Sara FowlerAbstract:Abstract Introduction In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the Pain of Injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection Pain was also studied. Methods One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the Pain of Injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes. Results Success was not significantly different ( P > .05) between the 2 combinations. No statistical differences in Injection Pain or onset times were found. Conclusions The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of Injection Pain, onset time, and pulpal anesthetic success for the IAN block.
John Nusstein - One of the best experts on this subject based on the ideXlab platform.
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maxillary lateral incisor Injection Pain using the dentapen electronic syringe
Journal of Endodontics, 2020Co-Authors: Brian B Partido, John Nusstein, Kyerston Miller, Mary LallyAbstract:Abstract Introduction When patients express fear and anxiety about dentistry, 1 main source involves the administration of local anesthetic. The Dentapen (Septodont, Lancaster, PA) is a computer-controlled local anesthetic device that regulates the rate of anesthetic deposition to reduce Pain associated with dental Injections. The purpose of this study was to evaluate differences in perceived Pain during the administration of local anesthesia of the maxillary lateral incisors using the ramp-up and continuous Injection modes of the Dentapen. Methods This study used a randomized, controlled, double-blind, crossover, experimental design. The investigators randomly assigned the order of the teeth (#7 or #10) and the 2 delivery modes (continuous or ramp-up). Participants completed a Corah dental anxiety scale at each visit and were injected on 2 separate visits at least 2 weeks apart. After each Injection, participants rated their perceived Pain using a Heft-Parker visual analog scale at needle insertion, needle placement, and solution deposition. Repeated measures analysis of variance was used to determine differences in perceived Pain between the 2 modes. Results The data from 116 participants were analyzed. The perceived Pain at deposition with the ramp-up mode (mean = 51.98, standard deviation = 30.04) was less than the continuous mode (mean = 59.98, standard deviation = 36.28) although not statistically significant (F1230 = 2.569, P > .05). Clinically, the perceived Pain with the ramp-up mode was in the mild range ( 54 mm). Conclusions Further research should evaluate whether the ramp-up mode could be used to reduce the Pain perceived with other dental Injections.
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is eye color related to dental Injection Pain a prospective randomized single blind study
Journal of Endodontics, 2018Co-Authors: Jason Hyde, John Nusstein, Al Reader, Sara Fowler, Melissa Drum, Mike BeckAbstract:Abstract Introduction Recent studies have investigated the relationship between Pain perception and specific phenotypes such as red hair color and various eye colors. Further investigations into biomarkers as they relate to Pain could be useful in understanding underlying genetic components involved in these pathways. Additionally, it would be clinically useful to determine if a patient would be more likely to experience Pain during dental treatment based on eye color. The purpose of this study was to investigate a link between eye color and perceived Injection Pain in healthy, asymptomatic white women. Methods Three hundred healthy, adult, white female patients were included, 133 with dark eyes and 167 with light eyes. Dental anxiety was assessed with the Corah Dental Anxiety Scale. Subjects with their eye color masked by dark glasses received a right maxillary lateral incisor infiltration of 1 cartridge of 2% lidocaine with 1:100,000 epinephrine. Patients rated their Injection Pain on a 170-mm Heft-Parker visual analog scale. Photographs of the subjects' eyes were taken after the infiltrations and categorized into dark- and light-eyed groups by 3 independent observers. Comparisons for Injection Pain were analyzed using analysis of variance and the Tukey-Kramer test. Results No significant differences were found for Pain of Injection between dark- or light-eyed subjects. Conclusions Eye color was not shown to be a predictor for Injection Pain in white women. Therefore, eye color would not be clinically useful in determining if a patient would be more likely to experience Pain during dental treatment.
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effect of buffered 4 lidocaine on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis a prospective randomized double blind study
Journal of Endodontics, 2015Co-Authors: Jared Schellenberg, John Nusstein, Al Reader, Sara Fowler, Melissa Drum, Mike BeckAbstract:Abstract Introduction Medical studies have suggested that buffering local anesthetic may increase the ability to achieve anesthesia. The purpose of this study was to determine the effect of 4% buffered lidocaine on the anesthetic success of the inferior alveolar nerve (IAN) block in patients experiencing symptomatic irreversible pulpitis. Methods One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received a conventional IAN block using either 2.8 mL 4% lidocaine with 1:100,000 epinephrine or 2.8 mL 4% lidocaine with 1:100,000 epinephrine buffered with sodium bicarbonate in a double-blind manner. For the buffered solution, each cartridge was buffered with 8.4% sodium bicarbonate using the OnPharma (Los Gatos, CA) system to produce a final concentration of 0.18 mEq/mL sodium bicarbonate. Fifteen minutes after administration of the IAN block, profound lip numbness was confirmed, and endodontic access was initiated. Success was defined as no or mild Pain (≤54 mm on a 170-mm visual analog scale) on access or instrumentation of the root canal. Results The success rate for the IAN block was 32% for the buffered group and 40% for the nonbuffered group, with no significant difference ( P = .4047) between the groups. Injection Pain ratings for the IAN block were not significantly ( P = .9080) different between the 2 formulations. Conclusions For mandibular posterior teeth, a 4% buffered lidocaine formulation did not result in a statistically significant increase in the success rate or a decrease in Injection Pain of the IAN block in patients with symptomatic irreversible pulpitis.
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does the combination of 3 mepivacaine plain plus 2 lidocaine with epinephrine improve anesthesia and reduce the Pain of anesthetic Injection for the inferior alveolar nerve block a prospective randomized double blind study
Journal of Endodontics, 2014Co-Authors: Emily Lammers, John Nusstein, Al Reader, Melissa Drum, Mike Beck, Sara FowlerAbstract:Abstract Introduction In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the Pain of Injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection Pain was also studied. Methods One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the Pain of Injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes. Results Success was not significantly different ( P > .05) between the 2 combinations. No statistical differences in Injection Pain or onset times were found. Conclusions The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of Injection Pain, onset time, and pulpal anesthetic success for the IAN block.
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comparison of Injection Pain heart rate increase and postInjection Pain of articaine and lidocaine in a primary intraligamentary Injection administered with a computer controlled local anesthetic delivery system
Anesthesia Progress, 2004Co-Authors: John Nusstein, Al Reader, Jeffrey Berlin, Michael W Beck, Joel M WeaverAbstract:The purpose of this prospective, randomized, double-blind study was to compare the Pain of Injection, heart rate increase, and postInjection Pain of the intraligamentary Injection of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine administered with a computer-controlled local anesthetic delivery system. Using a crossover design, intraligamentary Injections of 1.4 mL of 4% articaine with 1:100,000 epinephrine and 1.4 mL of 2% lidocaine with 1:100,000 epinephrine were randomly administered on the mesial and distal aspects of the mandibular first molar with a computer-controlled local anesthetic delivery system in a double-blind manner at 2 separate appointments to 51 subjects. The results demonstrated the incidence of moderate Pain was 14%-27% with needle insertion, with 0%-4% reporting severe Pain. For solution deposition, moderate Pain was reported 8%-18% of the time, with no reports of severe Pain. There were no significant differences between the articaine and lidocaine solutions. Regarding heart rate changes, neither anesthetic solution resulted in a significant increase in heart rate over baseline readings. On day 1 postInjection, there was a 31% incidence of moderate/severe Pain with the articaine solution and 20% incidence of moderate/severe Pain with the lidocaine solution. The moderate/severe Pain ratings decreased over the next 2 days. There were no significant differences between the articaine and lidocaine solutions. We concluded that the intraligamentary Injection of 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine for Injection Pain and postInjection Pain in the mandibular first molar when administered with a computer-controlled local anesthetic delivery system. For both anesthetic solutions, heart rate did not significantly increase with the intraligamentary Injection using the computer-controlled local anesthetic system.