16137
document
Injection pain and postinjection pain of the palatal-anterior superior alveolar injection , administered with the Wand Plus system , comparing 2 % lidocaine with 1:100,000 epinephrine to 3 % mepivacaine . PURPOSE The purpose of this prospective , randomized , double-blind study was to compare injection pain and postinjection pain of 2 % lidocaine with 1:100,000 epinephrine and 3 % mepivacaine using the computer-assisted Wand Plus injection system to administer the palatal-anterior superior alveolar ( P-ASA ) injection . Additionally study was done to determine if the use of topical anesthetic decreased the pain of needle insertion with the P-ASA injection . STUDY DESIGN Using a crossover design , 40 subjects randomly received , in a double-blind manner , P-ASA injections of 1.4 mL of 2 % lidocaine with 1:100,000 epinephrine and 1.4 mL of 3 % mepivacaine , at 2 separate appointments . The P-ASA injection was administered , utilizing the Wand Plus system , 6 to 10 mm into the incisive canal located lingual to the central incisors . The pain of needle insertion , needle placement , solution deposition and postinjection pain were recorded on a Heft-Parker visual analog scale for the 2 P-ASA injections . Eighty injections were randomly administered in the study , 40 using topical anesthetic gel and 40 using a placebo gel . RESULTS For needle insertion , 30 % of the subjects reported moderate/severe pain with the lidocaine solution and 43 % reported moderate/severe pain with the mepivacaine solution . There was no significant difference ( P > .05 ) between the topical and placebo groups . For needle placement into the incisive canal , 54 % of the subjects reported moderate/severe pain with the lidocaine solution and 58 % reported moderate/severe pain with the mepivacaine solution . For anesthetic solution deposition , 8 % of the subjects reported moderate pain with the lidocaine solution and 12 % reported moderate pain with the mepivacaine solution . There were no significant differences ( P > .05 ) between the lidocaine and mepivacaine solutions . Regarding postinjection pain , when anesthesia wore off on the day of the injection , 20 % of the subjects reported moderate/severe pain with the lidocaine solution and 14 % reported moderate/severe pain with the mepivacaine solution . Pain ratings decreased over the next 3 days . There were no significant differences ( P > .05 ) between the lidocaine and mepivacaine solutions . Postinjection , 12 % and 18 % of the subjects experienced temporary numbness/paresthesia of the incisive papilla with the lidocaine and mepivacaine solutions , respectively . Twenty percent and 28 % of the subjects had incisive papilla swelling or soreness with the lidocaine and mepivacaine solutions , respectively . There were no significant differences ( P > .05 ) between the lidocaine and mepivacaine solutions . CONCLUSIONS The P-ASA injection of 1.4 mL of 2 % lidocaine with 1:100,000 epinephrine or 3 % mepivacaine , administered with the Wand Plus , has the potential to be a painful injection . The use of topical anesthetic did not significantly reduce pain of needle insertion when compared to a placebo . The incidence of postinjection pain , temporary numbness/paresthesia , and incisive papilla swelling or soreness would indicate that some pain and problems occur with the P-ASA technique , regardless of whether 2 % lidocaine with 1:100,000 epinephrine or 3 % mepivacaine is used .
16138
Intervention_Pharmacological
lidocaine
16139
Intervention_Pharmacological
epinephrine
16140
Intervention_Pharmacological
mepivacaine
16141
Intervention_Pharmacological
topical anesthetic
16142
Intervention_Pharmacological
P-ASA injections of 1.4 mL of 2 % lidocaine
16143
Intervention_Pharmacological
epinephrine
16144
Intervention_Pharmacological
mepivacaine
16145
Intervention_Pharmacological
topical anesthetic gel
16146
Intervention_Control
placebo gel
16147
Intervention_Pharmacological
mepivacaine
16148
Intervention_Control
placebo
16149
Intervention_Pharmacological
lidocaine
16150
Intervention_Pharmacological
lidocaine
16151
Intervention_Pharmacological
mepivacaine
16152
Intervention_Pharmacological
lidocaine
16153
Intervention_Pharmacological
mepivacaine
16154
Intervention_Pharmacological
lidocaine
16155
Intervention_Pharmacological
mepivacaine
16156
Intervention_Pharmacological
lidocaine
16157
Intervention_Pharmacological
mepivacaine
16158
Intervention_Pharmacological
lidocaine
16159
Intervention_Pharmacological
mepivacaine
16160
Intervention_Pharmacological
lidocaine
16161
Intervention_Pharmacological
mepivacaine
16162
Intervention_Pharmacological
lidocaine
16163
Intervention_Pharmacological
mepivacaine
16164
Intervention_Pharmacological
lidocaine
16165
Intervention_Pharmacological
epinephrine
16166
Intervention_Pharmacological
mepivacaine
16167
Intervention_Control
placebo .
16168
Intervention_Pharmacological
lidocaine
16169
Intervention_Pharmacological
epinephrine
16170
Intervention_Pharmacological
mepivacaine
16171
Outcome_Pain
Injection pain and postinjection pain
16172
Outcome_Pain
injection pain
16173
Outcome_Pain
postinjection pain
16174
Outcome_Pain
pain
16175
Outcome_Pain
pain of needle insertion , needle placement , solution deposition and postinjection pain
16176
Outcome_Pain
moderate/severe pain
16177
Outcome_Pain
moderate/severe pain
16178
Outcome_Pain
moderate/severe pain
16179
Outcome_Pain
moderate/severe pain
16180
Outcome_Pain
moderate pain
16181
Outcome_Pain
moderate pain
16182
Outcome_Pain
postinjection pain
16183
Outcome_Pain
moderate/severe pain
16184
Outcome_Pain
moderate/severe pain
16185
Outcome_Pain
Pain ratings
16186
Outcome_Physical
temporary numbness/paresthesia of the incisive papilla
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Outcome_Physical
incisive papilla swelling
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Outcome_Physical
soreness
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Outcome_Pain
pain
16190
Outcome_Pain
postinjection pain
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Outcome_Pain
temporary numbness/paresthesia
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Outcome_Pain
incisive papilla swelling
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Outcome_Pain
soreness
16194
Participant_Sample-size
40