The Effectiveness of Different Lidocaine Combinations - Research Paper Example

Pain Management in Dentistry: The Effectiveness of Different Lidocaine Combinations Local anesthesia has been used in the field of dentistry to alleviate, if not to eliminate, pain which is inevitable in many dental procedures most especially in invasive ones. There are several substances used by dentists and dental hygienists in inducing anesthesia. In the United States, the most commonly used anesthetic substance is lidocaine which is delivered through inferior alveolar nerve block (as cited in Kanaa, Whitworth, Corbett & Meechan, 2009). However, the success rate of inducing anesthesia varies to the point that it can go as low as 30% (as cited in Kanaa et al., 2009). In an attempt to increase the effectiveness of lidocaine delivered through inferior alveolar nerve block, several experiments combining lidocaine with other substances have been conducted. Yet these studies have conflicting results. Nevertheless, the decision on using a particular lidocaine combination should lie on the validity and reliability of the experiments that support the use of such preparation because the effectiveness of anesthesia is very critical in delivering quality dental care. The study conducted by Kanaa et al. (2009) employed a randomized controlled double-blind cross-over research design to test the hypothesis that supplementary articaine infiltration is more effective than lidocaine inferior alveolar nerve block alone. The subjects were selected from a group of volunteers aged 18 years and above “with a vital mandibular first molar, first or second premolar and lateral incisor” (Kanaa et al., 2009) on either side and who were able to complete the trial experiment. Those who were pregnant and unhealthy such as those with allergy to amide local and those with bleeding and neurological disorders were excluded in the study. This resulted to a sample size consisting of 36 participants which is big enough considering that an earlier published and reviewed study indicated that this sample size had 90% power to detect a difference with a 21% success rate given a 5% significance level and a 0.5 correlation between responses from the same participant (as cited in Kanaa et al., 2009). However, the subjects were predominantly from the university and some are even dental students which do not necessarily reflect the actual population. This can also result to biases since the subjects have knowledge on the procedure being done; thus, their expectations may influence the result of the study. Nonetheless, this bias could possibly be resolved by the fact that the study was double blind such that in each of the two occasions in which each substance was tested, the subjects and the investigators were not made aware of the type of anesthestetic solution used. This eliminated bias from both the sample and the examiner. However, the participants’ expectations of pain serve as the confounding variable in the study. It can be noticed that there is an increased recorded discomfort in the second session of anesthesia conduction for both lidocaine solutions. This could perhaps be due to the participants’ tendency to anticipate pain in the second treatment session after experiencing it the first time. Nevertheless, the research is reliable because the same results were acquired for both the lidocaine solutions regardless of whether the solution was administered in the first session or in the second session. In addition, the flow of the paper is easy to follow because of the use of proper subheadings and tables and charts. On the other hand, in a similar study by Smith, Reader, Drum, Nusstein & Beck (2013), the type of study employed is a prospective, randomized, single-blind study to test the hypothesis that mannitol when combined with lidocaine is more effective in producing anesthetic effect than lidocaine alone. Just like the abovementioned study, the subjects were selected from a group of volunteers aged 18 years and above with no significant medical conditions and who are not taking any medications that may affect perception of pain. However, it was not mentioned whether the investigators assessed the vitality of the teeth to be tested although they made sure that there is no active pathosis at the site of injection. This resulted to a sample size consisting of 40 participants which is even larger than that used in the abovementioned study. It can be assumed that the sample population is heterogeneous and therefore reflect the actual population unlike the study of Kanaa et al. (2009) in which the subjects were mainly university students. As such, there is no bias in terms of the participants’ knowledge affecting the results of the study. However, the study was only single blind such that the investigators were aware of the type of the anesthetic being given to the subjects. But then again, there is no examiner’s bias because the response of the participants were recorded objectively using a standardized pain scale. The study is easy to follow because of its extensive use of tables and charts from where the results can easily be identified. In terms of how the paper was written, it could have been better if the population selection was explained further so as to ensure that no bias is present. The study can be further improved by making it double blind so that the possibility that the examiners’ actions to influence the participants will be eliminated. After analyzing how each of the experiments was done, it seems that it is more practical to use the combination of mannitol and lidocaine in inducing inferior alveolar nerve block. Aside from the fact the experiment by Smith et al. (2013) appears to be more valid and reliable, such combination entails only one injection unlike the solution proposed by Kanna et al. (2009) in which an additional buccal infiltration using articaine is required. It should be noted that not only the actual dental procedure itself causes pain but the mere administration of anesthesia through injection. In conclusion, the study of Smith et al. (2013) appears to be more valid and reliable because of the larger sample size and because the sample population reflects the actual population. Also, it seems that the study being single-blind did not affect the results especially because the responses were recorded objectively. Given the premise that the decision on the lidocaine combination to use lies on the validity and reliability of the experiment that supports each preparation, then clearly, the lidocaine-mannitol combination is more practical in ensuring quality and painless dental care. References Kanaa, M.D., Whitworth, J.M., Corbett, I.P. & Meechan, J.G. (2009). Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. International Endodontic Journal, 42: 238–246. Smith, S., Reader, A., Drum, M., Nusstein, J. & Beck, M. (2013). Anesthetic efficacy of a combination of 0.5 M mannitol plus 127.2 mg of lidocaine with 50 lg epinephrine in inferior alveolar nerve blocks: A prospective randomized, single-blind study. Anesthesia Progress, 60(3):3-10. Read More