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Title There is Significant Difference in Pain Perception Between Inferior Alveolar Nerve Block Technique Compared with Vazirani-Akinosi Technique
Clinical Question In a healthy patient undergoing local anesthesia of mandibular posterior teeth, will the perception of pain be elevated during penetration with conventional inferior alveolar block technique as compared to a Vazirani-Akinosi injection technique?
Clinical Bottom Line There is significant difference in pain perception between patients receiving local anesthesia with inferior alveolar nerve block technique compared with Vazirani-Akinosi technique. This is supported by the Gonzalez/2003 study in which pain sensation during puncture was greater using the conventional technique, with a mild to moderate degree of pain in 73% of the cases, while about 65% reported mild discomfort when anesthetized with Akinosi technique.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12618675Martinez Gonzalez/200356 patients having lower molar extractionsParallel-Group Trial
Key resultsPain sensation during injection "was greater in the group of patients subjected to the conventional technique (mild and moderate in 73% and 27% of cases, respectively). Of the patients anesthetized with the Akinosi technique,19% referred no pain, while 65% reported mild discomfort and 16% suffered moderate pain. The differences were statistically significant (ANOVA; p<0.05)."
#2) 12892444Jacobs/200360 patients receiving injectionsCross-Over Trial
Key resultsIn this study each subject "received two mandibular block injections bilaterally from three possible pairings: Gow-Gates/standard block, standard block/Vazirani-Akinosi or Gow-Gates/ Vazirani-Akinosi." “There were no significant differences in pain on injection among the three injection techniques. The subjects in the group that received N2O:O2 and the local anesthetic demonstrated a statistically significant reduction in pain on injection compared with subjects in the group that received the local anesthetic only (P < .05). When N2O:O2 was used, there was a statistically significant decrease in pain with the first injection (P < .0005), an effect not seen with the second injection (Jacobs/2003)”.
Evidence Search Akinosi AND inferior alveolar nerve block AND pain
Comments on
The Evidence
Factors that argue in favor of the results of Jacobs/2003 are the blinding of patients and the strength of the study design; it was a crossover trial, so the patients were their own controls. Jacobs/2003 factored in use of nitrous oxide, which lowered perception of pain with only the first injections; there was not a significant difference in pain perception for subsequent injections given. Gonzalez/2003 was a parallel-group trial (each patient got either conventional or V-A technique, but not both). A crossover trial is a much stronger study design for comparing two injection techniques. Many factors are involved in elevation of pain between different patients. For example, having a painful experience in the past may elevate anxiety and increase the perception of pain in one patient compared to a patient who is calmer. Use of nitrous oxide may decrease pain perception slightly as mentioned in one study listed above. To better understand perception of pain from injection techniques, a comparison should be done with other factors included, such as a patient pool with anxiety, nitrous oxide use, or similar age group. Injection technique alone may not be a good comparison.
Applicability Overall, the comparison of pain perception between mandibular inferior alveolar block technique and Vazirani-Akinosi technique are applicable to healthy patients. Patients will not experience significant difference in how much pain they perceive based solely on the injection technique. Other factors may play a larger role in elevation or a decrease in pain perception such as preoperative anxiety as well as use of nitrous oxide.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Restorative Dentistry)
Keywords Vazirani-Akinosi, inferior alveolar nerve block, pain
ID# 3241
Date of submission: 04/26/2017spacer
Author Mariyam Shah
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS
Faculty mentor/Co-author e-mail spackman@uthsca.edu
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