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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) 12618675 | Martinez Gonzalez/2003 | 56 patients having lower molar extractions | Parallel-Group Trial | | Key results | Pain 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) 12892444 | Jacobs/2003 | 60 patients receiving injections | Cross-Over Trial | | Key results | In 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: |
04/26/2017 |
| E-mail |
SHAHMN@LIVEMAIL.UTHSCSA.EDU |
| Author |
Mariyam Shah |
| Co-author(s) |
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| Co-author(s) e-mail |
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| Faculty mentor/Co-author |
Gregory K. Spackman, DDS, MBA |
| Faculty mentor/Co-author e-mail |
spackman@uthsca.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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