国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (4): 373-379.doi: 10.7518/gjkq.2021080

• 专家笔谈 •    下一篇

口腔局部麻醉新概念

赵吉宏()   

  1. 武汉大学口腔医院口腔外科 武汉 430079
  • 收稿日期:2020-12-05 修回日期:2021-03-02 出版日期:2021-07-01 发布日期:2021-06-30
  • 通讯作者: 赵吉宏
  • 作者简介:赵吉宏,教授,硕士,Email:<email>jhzhao988@whu.edu.cn</email>;赵吉宏,主任医师、硕士研究生导师;武汉大学口腔医院口腔外科主任,医学伦理委员会主任,口腔颌面外科学教研室副主任;中华口腔医学会牙及牙槽外科专业委员会副主任委员,口腔颌面外科专业委员会委员,口腔美学专业委员会委员;中国整形美容学会口腔整形美容分会副会长;国际血管联盟中国分部专家委员会委员;湖北省口腔医学会常务理事,湖北省牙槽外科及镇静镇痛联合专业委员会主任委员,湖北省口腔美学专业委员会前任主任委员;武汉市口腔医学会常务理事,武汉市口腔颌面外科专业委员会主任委员。主要研究领域为口腔颌面部血管瘤及血管畸形的综合治疗、牙槽外科、第三磨牙的科学化管理等。主持或参与国家自然科学基金及省市级科研项目10余项;主编著作2部,副主编著作5部,参编参译著作10余部,在国内外相关学术期刊上发表学术论文50余篇;合作课题获得国家级科技进步二等奖1项、省部级科技进步一等奖1项、省部级科技进步三等奖3项。
  • 基金资助:
    国家自然科学基金(81671008)

Novel concepts of dental local anesthesia

Zhao Jihong()   

  1. Dept. of Oral Surgery, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2020-12-05 Revised:2021-03-02 Online:2021-07-01 Published:2021-06-30
  • Contact: Jihong Zhao
  • Supported by:
    National Natural Science Foundation of China(81671008)

RichHTML

744

PDF (PC)

4785

摘要：

本文介绍了口腔局部麻醉的一些新理念和新技术。强调口腔局部麻醉前对患者的身体状况及心理状态进行评估,根据身体状态评估结果合理用药,对紧张恐惧的患者进行必要的心理疏导或镇静,是保证局部麻醉安全的重要措施;阿替卡因等局部麻醉药物具有较高的安全性和较好的麻醉效果,已经在临床得以广泛应用,适用的局部麻醉方式也呈多样化趋势;新型无痛注射器能为患者带来舒适无痛的局部麻醉感受,同时为局部麻醉安全增添了一份保险;良好的局部麻醉药和无痛注射器的应用,带来了局部麻醉方式和技术的相应改变,局部浸润麻醉逐步成为口腔临床治疗首选的局部麻醉方式,牙周膜麻醉成为常规局部麻醉方式,还有一些具有针对性和特色的神经阻滞麻醉应运而生;口腔局部麻醉的安全、舒适和效果,归根结底在于规范化操作,因此口腔局部麻醉操作规范的制订十分必要,该工作已经在中华口腔医学会立项并启动。

关键词: 口腔治疗, 局部麻醉, 安全, 舒适, 规范

Abstract:

This article introduces some new concepts and techniques of local anesthesia for dental treatment. The signi-ficant measures that ensure local anesthesia’s safety are to evaluate the dental patients’ physical and mental state before local anesthesia, rationally use drugs depending on the results of physical state evaluation, and conduct necessary psychological counseling sedation for nervous and fearful patients. Articaine is highly prevalent in clinical practices because of its relative safety, good anesthetic efficacy, and diversity of applicable methods. The new painless syringes will make patients comfortable with local anesthesia and improve the safety of local anesthesia. The application of proper local anesthetics and painless needles will bring about several changes in local anesthesia methods and techniques. Local infiltration anesthesia has become the first choice of local anesthesia for dental treatment. Periodontal membrane anesthesia has become routine anesthesia, and customized and distinctive nerve block anesthesia has emerged. The safety, comfort, and efficacy of local anesthesia depend on the standardized operation. Under this circumstance, an imperative formulation of “Ope-rational Standard of Oral Local Anesthesia” has been established in the Chinese Stomatological Association.

Key words: dental treatment, local anesthesia, safety, comfort, standard

中图分类号: 

  • R782.05
[1] 胡开进. 牙及牙槽外科学[M]. 北京: 人民卫生出版社, 2016: 40-73.
Hu KJ. Dental and alveolar surgery[M]. Beijing: Peo-ple’s Medical Publishing House, 2016: 40-73.
[2] 赵吉宏. 现代牙槽外科新技术[M]. 北京: 人民卫生出版社, 2017: 54-64.
Zhao JH. New technology of modern alveolar surge-ry[M]. Beijing: People’s Medical Publishing House, 2017: 54-64.
[3] Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review[J]. Aust Dent J, 2013,58(4):390-407.
doi: 10.1111/adj.12118 pmid: 24320894
[4] Sambrook PJ, Smith W, Elijah J, et al. Severe adverse reactions to dental local anaesthetics: systemic reactions[J]. Aust Dent J, 2011,56(2):148-153.
doi: 10.1111/j.1834-7819.2011.01316.x pmid: 21623805
[5] Gómez-Moreno G, Guardia J, Cutando A, et al. Pharmacological interactions of vasoconstrictors[J]. Med Oral Patol Oral Cir Bucal, 2009,14(1):E20-E27.
[6] Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept[J]. Reg Anesth Pain Med, 2004,29(6):564-575.
[7] Fiorillo L. Conscious sedation in dentistry[J]. Medicina, 2019,55(12):778.
doi: 10.3390/medicina55120778
[8] Zeytinoğlu M, Tuncay Ü, Akay MC, et al. Holter ECG assessment of the effects of three different local anesthetic solutions on cardiovascular system in the sedated dental patients with coronary artery di-sease[J]. Anatol J Cardiol, 2013,13(5):480-485.
[9] Sierra Rebolledo A, Delgado Molina E, Berini Aytís L, et al. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars[J]. Med Oral Patol Oral Cir Bucal, 2007,12(2):E139-E44.
[10] Srisurang S, Narit L, Prisana P. Clinical efficacy of lidocaine, mepivacaine, and articaine for local infiltration[J]. J Investig Clin Dent, 2011,2(1):23-28.
doi: 10.1111/jicd.2011.2.issue-1
[11] 丁晟, 朱亚琴, 吴英娜, 等. 3%盐酸甲哌卡因用于口腔局麻的有效性和安全性评价[J]. 上海口腔医学, 2008,17(3):328-331.
Ding S, Zhu YQ, Wu YN, et al. Efficacy and safety of 3% mepivacaine hydrochloride injection for oral local anesthesia[J]. Shanghai J Stomatol, 2008,17(3):328-331.
[12] Trullenque-Eriksson A, Guisado-Moya B. Comparative study of two local anesthetics in the surgical extraction of mandibular third molars: bupivacaine and articaine[J]. Med Oral, 2011: e390-e396.
[13] Velioglu O, Calis AS, Koca H, et al. Bupivacaine vs. lidocaine: a comparison of local anesthetic efficacy in impacted third molar surgery[J]. Clin Oral Investig, 2020,24(10):3539-3546.
doi: 10.1007/s00784-020-03224-5 pmid: 32065309
[14] Kennedy M, Reader A, Beck M, et al. Anesthetic efficacy of ropivacaine in maxillary anterior infiltration[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2001,91(4):406-412.
doi: 10.1067/moe.2001.114000
[15] Vasters FG, Eberhart LH, Koch T, et al. Risk factors for prilocaine-induced methaemoglobinaemia follo-wing peripheral regional anaesthesia[J]. Eur J A-naesthesiol, 2006,23(9):760-765.
[16] Thoppe-Dhamodhara YK, Asokan S, John BJ, et al. Cartridge syringe vs computer controlled local anesthetic delivery system: pain related behaviour over two sequential visits‒a randomized controlled trial[J]. J Clin Exp Dent, 2015,7(4):e513-e518.
[17] Kwak EJ, Pang NS, Cho JH, et al. Computer-controlled local anesthetic delivery for painless anesthesia: a literature review[J]. J Dent Anesth Pain Med, 2016,16(2):81-88.
doi: 10.17245/jdapm.2016.16.2.81
[18] Munshi AK, Hegde A, Bashir N. Clinical evaluation of the efficacy of anesthesia and patient preference using the needle-less jet syringe in pediatric dental practice[J]. J Clin Pediatr Dent, 2001,25(2):131-136.
pmid: 11314212
[19] Moore PA, Cuddy MA, Cooke MR, et al. Periodontal ligament and intraosseous anesthetic injection te-chniques: alternatives to mandibular nerve blocks[J]. J Am Dent Assoc, 2011,142(Suppl 3):13S-18S.
doi: 10.14219/jada.archive.2011.0342
[20] Kleber CH. Intraosseous anesthesia: implications, instrumentation and techniques[J]. J Am Dent Assoc, 2003,134(4):487-491.
doi: 10.14219/jada.archive.2003.0200
[21] Flanagan D. The effectiveness of articaine in mandibular facial infiltrations[J]. Local Reg Anesth, 2015: 1-6.
[22] Friedman MJ, Hochman MN. P-ASA block injection: a new palatal technique to anesthetize maxillary anterior teeth[J]. J Esthet Dent, 1999,11(2):63-71.
pmid: 10530269
[23] Friedman MJ, Hochman MN. The AMSA injection: a new concept for local anesthesia of maxillary tee-th using a computer-controlled injection system[J]. Quintessence Int, 1998,29(5):297-303.
pmid: 9693648
[24] de Souza Tolentino L, Barbisan Souza A, Girardi AA, et al. The anesthetic effect of anterior middle superior alveolar technique (AMSA)[J]. Anesth Prog, 2015,62(4):153-158.
doi: 10.2344/13-00013.1 pmid: 26650493
[25] AlHindi M, Rashed B, AlOtaibi N. Failure rate of inferior alveolar nerve block among dental students and interns[J]. Saudi Med J, 2016,37(1):84-89.
doi: 10.15537/smj.2016.1.13278 pmid: 26739980
[26] Aggarwal V, Singla M, Kabi D. Comparative evalua-tion of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi techni-que, buccal-plus-lingual infiltrations, and conventio-nal inferior alveolar nerve anesthesia in patients with irreversible pulpitis[J]. Oral Surg Oral Med Oral Pa-thol Oral Radiol Endodontology, 2010,109(2): 303-308.
[27] Sokhov ST, Rabinovich SA, Bogaevskaya OY. Comparative evaluation of P.M. Egorov and modified G. Gow-Gates mandibular block efficacy[J]. Stomatologiia (Mosk), 2019,98(5):46-49.
doi: 10.17116/stomat20199805146 pmid: 31701928
[28] Haas DA. Alternative mandibular nerve block techniques: a review of the Gow-Gates and Akinosi-Vazirani closed-mouth mandibular nerve block techni-ques[J]. J Am Dent Assoc, 2011,142(Suppl 3):8S-12S.
doi: 10.14219/jada.archive.2011.0341
[29] Mulroy MF. Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures[J]. Reg Anesth Pain Med, 2002,27(6):556-561.
[30] Malamed, Stanley F. Medical emergencies in the dental office[M]. St. Louis, Missouri: Elsevier Health Sciences>, 2014: 125-143.
[1] 谭永臻,梁新华. 口腔局部麻醉药抗菌机制的研究进展[J]. 国际口腔医学杂志, 2024, 51(1): 74-81.
[2] 范琳,孙江. 微针在口腔医学中的应用[J]. 国际口腔医学杂志, 2023, 50(4): 472-478.
[3] 张麒麟,李军,李姝慧. 根管预备机用镍钛锉的研究进展[J]. 国际口腔医学杂志, 2022, 49(6): 663-669.
[4] 张雪雯,李聪,徐小茵,高静,申静. 混合光源系统用于活髓牙漂白的临床研究进展[J]. 国际口腔医学杂志, 2021, 48(6): 683-689.
[5] 赵金,赖光云,汪俊. 全身麻醉下儿童口腔疾病治疗家长接受度现况的研究进展[J]. 国际口腔医学杂志, 2018, 45(6): 739-744.
[6] 关淑元, 周媛, 周学东, 郑黎薇. 孕前口腔保健及遗传咨询[J]. 国际口腔医学杂志, 2018, 45(3): 324-330.
[7] 宋韬,王冏珂,文静,陈谦明,曾昕. 沙利度胺在口腔黏膜病临床治疗实践中的安全性分析[J]. 国际口腔医学杂志, 2016, 43(3): 366-370.
[8] 赵静子1 张文君2 张晓东2. 上颌后牙区正畸微种植体支抗植入安全区的测量研究[J]. 国际口腔医学杂志, 2015, 42(6): 659-663.
[9] 杨腾宇 苏乃川 潘剑 郑黎薇. 骨内麻醉技术在牙科治疗中的研究进展[J]. 国际口腔医学杂志, 2014, 41(5): 559-562.
[10] 刘艳梅 刘楠 李馨. 计算机控制局部麻醉系统的应用研究[J]. 国际口腔医学杂志, 2013, 40(4): 451-453.
[11] 陈敏乐 丁江峰综述 江千舟 何邕江审校. Er：YAG 激光在口腔医学中的应用[J]. 国际口腔医学杂志, 2012, 39(6): 797-800.
[12] 李灏来1，2 杨丽3 赵晓曦1，2 高原3 王潇3 尹仕海1，2. 自制的简易咬合块在口腔临床治疗中的应用[J]. 国际口腔医学杂志, 2012, 39(4): 432-434.
[13] 潘剑 张壮. 口腔局部麻醉的并发症及其防治[J]. 国际口腔医学杂志, 2012, 39(2): 141-144.
[14] 李桦综述 胡敏审校. 含镍合金在正畸治疗中生物安全性的研究进展[J]. 国际口腔医学杂志, 2012, 39(2): 233-236.
[15] 陈静 王璟综述 赖文莉审校. 认知行为疗法在口腔治疗中的应用[J]. 国际口腔医学杂志, 2011, 38(4): 488-491.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 张新春. 桩冠修复与无髓牙的保护[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 王昆润. 长期单侧鼻呼吸对头颅发育有不利影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[3] 彭国光. 颈淋巴清扫术中颈交感神经干的解剖变异[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 杨凯. 淋巴化疗的药物运载系统及其应用现状[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 康非吾. 种植义齿下部结构生物力学研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 柴枫. 可摘局部义齿用Co-Cr合金的激光焊接[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 孟姝,吴亚菲,杨禾. 伴放线放线杆菌产生的细胞致死膨胀毒素及其与牙周病的关系[J]. 国际口腔医学杂志, 2005, 32(06): 458 -460 .
[8] 费晓露,丁一,徐屹. 牙周可疑致病菌对口腔黏膜上皮的粘附和侵入[J]. 国际口腔医学杂志, 2005, 32(06): 452 -454 .
[9] 赵兴福,黄晓晶. 变形链球菌蛋白组学研究进展[J]. 国际口腔医学杂志, 2008, 35(S1): .
[10] 庞莉苹,姚江武. 抛光和上釉对陶瓷表面粗糙度、挠曲强度及磨损性能的影响[J]. 国际口腔医学杂志, 2008, 35(S1): .