Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial
Arunajatesan Subbiya, Paul V Abbott, Nagarajan Geethapriya, Suresh Mitthra, Venkatachalam Prakash
Keywords :
Double-blind control trial, Lidocaine, Local infiltration, Pain intensity, Topical anesthetic
Citation Information :
Subbiya A, Abbott PV, Geethapriya N, Mitthra S, Prakash V. Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial. J Contemp Dent Pract 2022; 23 (10):1016-1020.
Aim: The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA).
Materials and methods: In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study.
Results: A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers.
Conclusion: Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application.
Clinical significance: Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.
Nusstein JM, Beck M. Effectiveness of 20% benzocaine as a topical anesthetic for intraoral injections. Anesth Prog 2003;50(4):159–163. PMID: 14959903.
Facco E, Zanette G. The odyssey of dental anxiety: From prehistory to the present. A narrative review. Front Psychol 2017;8:1155. PMCID: PMC5504153.
Humphris G, King K. The prevalence of dental anxiety across previous distressing experiences. J Anxiety Disord 2011; 25(2):232–236. PMID: 20952156.
Aggarwal V, Singla M, Subbiya A, et al. Effect of preoperative pain on inferior alveolar nerve block. Anesth Prog 2015; 62(4):135–139. DOI: 10.2344/15-00019.1.
Hutchins HS Jr, Young FA, Lackland DT, et al. The effectiveness of topical anesthesia and vibration in alleviating the pain of oral injections. Anesth Prog 1997;44(3):87–89. PMCID: PMC2148927.
Nakanishi O, Haas D, Ishikawa T, et al. Efficacy of mandibular topical anesthesia varies with the site of administration. Anesth Prog 1996;43(1):14–19. PMCID: PMC2153448.
Fukayama H, Suzuki N, Umino M. Comparison of topical anesthesia of 20% benzocaine and 60% lidocaine gel. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94(2):157–161. PMID: 12221381.
DiFelice MG, Vandewalle KS, Maller SC, et al. Effects of a vibratory device on pain from anesthetic injections. Compend Contin Educ Dent 2014;35(4):246–248. PMID: 24773250.
Bhalla J, Meechan JG, Lawrence HP, et al. Effect of time on clinical efficacy of topical anesthesia. Anesth Prog 2009;56(2):36–41. PMID: 19642717.
Parirokh M, Sadeghi AS, Nakhaee N, et al. Effect of topical anesthesia on pain during infiltration injection and success of anesthesia for maxillary central incisors. J Endod 2012;38(12):1553–1556. DOI: 10.1016/j.joen.2012.08.011.
Rosa AL, Sverzut CE, Xavier SP, et al. Clinical effectiveness of lidocaine and benzocaine for topical anesthesia. Anesth Prog 1999;46(3):97–99. PMID: 11692349.
Rosivack RG, Koenigsberg SR, Maxwell KC. An analysis of the effectiveness of two topical anesthetics. Anesth Prog 1990;37(6):290–292. PMID: 2097909.
Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med 2016;16(4):237–244. PMID: 28879311.
Cho SY, Kim E, Park SH, et al. Effect of topical anesthesia on pain from needle insertion and injection and its relationship with anxiety in patients awaiting apical surgery: A randomized double-blind clinical trial. J Endod 2017;43(3):364–369. DOI: 10.1016/j.joen.2016.10.036.
Stonelake S, Thomson P, Suggett N. Identification of the high risk emergency surgical patient: Which risk prediction model should be used? Ann Med Surg 2015;4(3):240–247. PMID: 26468369.
Kim TK. Practical statistics in pain research. Korean J Pain 2017;30(4):243–249. DOI: 10.3344/kjp.2017.30.4.243.
Al-Delayme RE. A comparison of two anesthesia methods for the surgical removal of maxillary third molars: PSA nerve block technique vs. local infiltration technique. J Clin Exp Dent 2014;6(1):e12–16. PMCID: PMC3935899.
Tateno K, Inoue K, Sato T, et al. Differences in the degree of infiltration of local anesthesia according to the site of injection in rats. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(2):e6–10. DOI: 10.1016/j.tripleo.2008.03.034.
Meechan JG, Thomason JM. A comparison of 2 topical anesthetics on the discomfort of intraligamentary injections: a double-blind, split-mouth volunteer clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87(3):362–365. DOI: 10.1016/s1079-2104(99)70224-6.
Meechan JG, Winter RA. A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra-oral injections. Br Dent J 1996;181(9):333–335. PMID: 8972953.
Al-Melh MA, Andersson L. Comparison of topical anesthetics (EMLA/Oraqix vs. benzocaine) on pain experienced during palatal needle injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(5):e16–20. DOI: 10.1016/j.tripleo.2006.11.033.