Int J Stomatol

Int J Stomatol ›› 2026, Vol. 53 ›› Issue (1): 1-9.doi: 10.7518/gjkq.2026001

• Expert Forum •     Next Articles

Analgesia-first: new advancements in comfortable dental care

Chao Zhang(),Nan Zhao,Cong Yu()   

  1. Chongqing Key Laboratory of Oral Diseases & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education & Dept. of Anesthesiology, the Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing 401146, China
  • Received:2025-08-25 Revised:2025-09-23 Online:2026-01-01 Published:2025-12-31
  • Contact: Cong Yu E-mail:500822@hospital.cqmu.edu.cn;500158@hospital.cqmu.edu.cn
  • Supported by:
    Joint Project of Chongqing Science and Health Bureau(2025MSXM107);2025 Research Project on Tea-ching Reform of Higher Education of Chongqing(253076);2025 Key Educational and Teaching Projects of the Stomatological College of Chongqing Medical University(KQJ202502)

RichHTML

8

PDF (PC)

39

Abstract:

Comfort-oriented dental technology has reached a high level of maturity. This review focuses on pain ma-nagement in dental procedures, examining recent advancements and analyzing the critical role of perioperative pain ma-nagement in enhancing patient experience, reducing dental anxiety, and optimizing clinical outcomes. Through literature review and the authors’ clinical practice, we analyze the current status and challenges of novel analgesic techniques/pharmaceuticals, comfort management strategies, and related technological applications. This synthesis provides valuable insights for the future development of comfort-oriented dental care.

Key words: comfortable oral diagnosis and treatment, multimodal analgesia, sedation technology, postoperative pain management

CLC Number: 

  • R782.05＋4

TrendMD: 

Tab 1

Sedation and general anesthesia techniques in dental treatment"

镇静方式方法适用情况优势/备注
吸入镇静使用氧化亚氮（笑气）与氧气混合，通过鼻罩吸入，达到轻度镇静轻度至中度焦虑患者，常用于简单或短时治疗起效快，恢复迅速，安全性高，需生命体征监测
口服/经鼻镇静苯二氮卓类药物口服或右美托咪定鼻喷雾，达到轻中度镇静以减轻焦虑中度焦虑患者，需提前使用，必要时可配合吸入镇静需生命体征监测
静脉镇静通过静脉给予镇静剂（如丙泊酚、瑞马唑仑），使患者进入中深度镇静状态重度焦虑或复杂种植，口腔外科手术需麻醉医师实施及生命体征监测
全身麻醉在全身麻醉及气管插管下实施，全程在麻醉医师严密管理下进行低龄儿童复杂龋坏牙治疗或者特殊人群的口腔治疗由麻醉医师实施及全程监测管理

Tab 2

Comparison of the characteristics of three central analgesic drugs in outpatient operation anesthesia"

特性艾司氯胺酮富马酸奥赛立定盐酸阿芬太尼
作用机制N-甲基-D-天冬氨酸（N-methyl-D-aspartate，NMDA）受体拮抗剂偏向性μ阿片受体激动剂μ阿片受体激动剂
起效时间快速（静脉推注：30 s~1 min）快速（静脉推注：1~3 min）极快（静脉推注：30 s~1 min）
持续时间短效（30~60 min）短效（1~3 h）极短效（10~20 min）
门诊手术适用性适合短时手术，尤其适合高风险患者（如老年或心血管疾病患者）适合术后疼痛管理，尤其在急性中重度疼痛中适合短时手术，需联合镇静剂
镇痛效果强效镇痛，适用于术中和术后疼痛管理强效镇痛，适用于术后急性疼痛管理强效镇痛，适用于术中短时疼痛控制
呼吸抑制风险低，呼吸和循环稳定性高较低，低于传统阿片类药物中等，较其他阿片类药物低
心血管稳定性高，偶见心率或血压轻度升高高，较传统阿片类药物更稳定高，较少影响心血管功能
术后恢复快速恢复，适合门诊手术恢复较快，但需警惕呼吸抑制风险极快恢复，适合短时门诊手术
常见不良作用恶心、呕吐、眩晕、精神症状恶心、呕吐、头晕、嗜睡恶心、呕吐、呼吸抑制、肌肉僵硬
给药途径静脉、肌注、鼻腔喷雾静脉注射静脉注射
优点

①呼吸/循环稳定性高

②支持无阿片麻醉（opioid-free anesthesia，OFA）

③快速恢复

④多途径给药

①较低呼吸抑制风险

②强效镇痛

③适合术后患者自控镇痛（patient controlled analgesia，PCA）

①起效极快

②作用时间短

③适合快速手术

④呼吸抑制较轻

局限性

①可能引起精神症状

②需专业监护

①仍属阿片类药物

②潜在依赖性

③需要进一步研究

①需静脉给药

②需联合镇静剂

③术后恶心呕吐风险

Tab 3

Analgesic schemes with different pain degrees"

疼痛程度手术类型药物治疗注意事项
轻度大部分口腔门诊操作布洛芬或对乙酰氨基酚

①冰敷

②患者心理教育

随访有无胃肠道不适症状
中度及重度复杂智齿拔除和（或）种植手术布洛芬或（和）对乙酰氨基酚

①冰敷

②患者心理干预

③长效局部麻醉药物

①随访有无胃肠道不适症状

②随访以预防镇痛不足

[1] 洪飞若, 陈飘飘, 俞雪芬, 等. 中国成年人牙科焦虑症患病率的Meta分析[J]. 华西口腔医学杂志, 2023, 41(1): 88-98.
Hong FR, Chen PP, Yu XF, et al. Prevalence of dental anxiety among adults in China: a meta-analysis[J]. West China J Stomatol, 2023, 41(1): 88-98.
[2] Nermo H, Petrenya N, Steingrímsdóttir ÓA, et al. Experimental pain tolerance is associated with dental anxiety-the Tromsø study 2015-2016[J]. BMC Oral Health, 2025, 25(1): 1096.
[3] Gonçalves RCG, Cardoso RB, Bauer J, et al. Exploring the relationship between anxiety, patient characteristics and pain outcomes in oral surgery under local anesthesia: the measurement problem[J]. Dent Med Probl, 2024, 61(4): 515-523.
[4] Milgrom P, Fiset L, Melnick S, et al. The prevalence and practice management consequences of dental fear in a major US city[J]. J Am Dent Assoc, 1988, 116(6): 641-647.
[5] McNeil DW, Randall CL. Dental fear and anxiety associated with oral health care: conceptual and cli-nical issues[M]//Mostofsky DI, Fortune F. Behavio-ral dentistry. 2nd ed. Oxford: Wiley, 2014: 165-192.
[6] 中华口腔医学会. 口腔局部麻醉操作规范: T/ [S]. 中华口腔医学会: 2023.
Chinese Stomatological Association. Guideline for oral local anesthesia: T/ [S]. Chinese Stomatological Association: 2023.
[7] 赵鑫, 刘红玲, 秦满. 计算机控制下局部麻醉注射系统在儿童的应用[J]. 华西口腔医学杂志, 2011, 29(4): 389-392.
Zhao X, Liu HL, Qin M. Application of computer-controlled local anesthetic delivery system in children[J]. West China J Stomatol, 2011, 29(4): 389-392.
[8] Shirani M, Looha MA, Emami M. Comparison of injection pain levels using conventional and compu-ter-controlled local anesthetic delivery systems in pediatric dentistry: a systematic review and meta-analysis[J]. J Dent, 2025, 157: 105770.
[9] Barrington MJ, Uda Y. Did ultrasound fulfill the promise of safety in regional anesthesia[J]. Curr Opin Anaesthesiol, 2018, 31(5): 649-655.
[10] Perisanidis C, Saranteas T, Kostopanagiotou G. Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery[J]. Dentomaxillofac Radiol, 2013, 42(2): 29945724.
[11] Cao ZW, Zhang K, Hu LR, et al. Application of ultrasound guidance in the oral and maxillofacial nerve block[J]. PeerJ, 2021, 9: e12543.
[12] Chen HY, Meng XY, Gao H, et al. Esketamine-based opioid-free anaesthesia alleviates postoperative nausea and vomiting in patients who underwent laparoscopic surgery: study protocol for a rando-mized, double-blinded, multicentre trial[J]. Trials, 2023, 24(1): 13.
[13] Zhang C, He JQ, Shi QY, et al. Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial[J]. BMC Anesthesiol, 2022, 22(1): 138.
[14] Daksla N, Wang A, Jin ZS, et al. Oliceridine for the management of moderate to severe acute postoperative pain: a narrative review[J]. Drug Des Devel Ther, 2023, 17: 875-886.
[15] Kaye AD, Edinoff AN, Babin KC, et al. Pharma-cological advances in opioid therapy: a review of the role of oliceridine in pain management[J]. Pain Ther, 2021, 10(2): 1003-1012.
[16] Zhao N, Zeng J, Fan L, et al. The effect of alfentanil on emergence delirium following general anesthesia in children: a randomized clinical trial[J]. Paediatr Drugs, 2022, 24(4): 413-421.
[17] Merry AF, Gibbs RD, Edwards J, et al. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial[J]. Br J Anaesth, 2010, 104(1): 80-88.
[18] Mokhtari T, Ren QY, Li N, et al. Transcutaneous electrical nerve stimulation in relieving neuropathic pain: basic mechanisms and clinical applications[J]. Curr Pain Headache Rep, 2020, 24(4): 14.
[19] Rebekah R, Navaneethan R, Nagachandran KS. Effect of transcutaneous electrical nerve stimulation therapy on condylar position and myofascial pain in patients with temporomandibular joint disorders-a pilot clinical trial[J]. J Orthod Sci, 2024, 13: 36.
[20] Gupta A, Scott K, Dukewich M. Innovative techno-logy using virtual reality in the treatment of pain: does it reduce pain via distraction, or is there more to it[J]. Pain Med, 2018, 19(1): 151-159.
[21] Bleyen S, Mooens K, Jancic L, et al. Virtual reality for patients with dental anxiety: a scoping review[J]. J Dent, 2025, 160: 105905.
[22] Fan L, Zeng J, Ran LK, et al. Virtual reality in ma-naging dental pain and anxiety: a comprehensive review[J]. Front Med, 2023, 10: 1285142.
[23] Ran LK, Zhao N, Fan L, et al. Application of virtual reality on non-drug behavioral management of short-term dental procedure in children[J]. Trials, 2021, 22(1): 562.
[24] Hole J, Hirsch M, Ball E, et al. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis[J]. Lancet, 2015, 386(10004): 1659-1671.
[25] Yazar M, Aydınoğlu S, Günaçar DN. Are technological contributions in behavior guidance techniques superior to conventional methods: effects on dental anxiety and pain perception[J]. BMC Oral Health, 2025, 25(1): 735.
[26] Ruiz Hernández C, Gómez-Urquiza JL, Pradas-Hernández L, et al. Effectiveness of nursing interventions for preoperative anxiety in adults: a systematic review with meta-analysis[J]. J Adv Nurs, 2021, 77(8): 3274-3285.
[27] Philippe TJ, Sikder N, Jackson A, et al. Digital health interventions for delivery of mental health care: systematic and comprehensive meta-review[J]. JMIR Ment Health, 2022, 9(5): e35159.
[28] Li HY, Chiu PL, Efendi D, et al. Effects of virtual reality-based interventions on preoperative anxiety in patients undergoing elective surgery with anesthesia: systematic review and meta-analysis[J]. J Med Internet Res, 2025, 27: e55291.
[29] Malamed SF. Pain management following dental trauma and surgical procedures[J]. Dent Traumatol, 2023, 39(4): 295-303.
[30] ADA. New guideline details acute pain management strategies for adolescent, adult dental patients[EB/OL]. (2024-02-05)[2025-07-29]. .
[31] Gordon SM. My view: new guidelines emphasize safer, more effective pain management[EB/OL]. (2024-02-05) [2025-07-29]. .
[32] ADA. Oral analgesics for acute dental pain[EB/OL]. (2024-02-02) [2025-07-29]. .
[33] Carrasco-Labra A, Polk DE, Urquhart O, et al. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: a report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania[J]. J Am Dent Assoc, 2024, 155(2): 102-117.e9.
[34] Leaver ES. ADA releases guideline on dental pain management in adults, adolescents[EB/OL]. (2024-02-05) [2025-07-29]. .
[35] CDC. Dental pain care[EB/OL]. (2024-05-08)[2025-07-29]. .
[36] ADA. Antibiotics for dental pain and swelling gui-deline[EB/OL]. (2019-10-01)[2025-07-29]. .
[37] 冷希圣, 韦军民, 刘连新, 等. 普通外科围手术期疼痛处理专家共识[J]. 中华普通外科杂志, 2015, 30(2): 166-173.
Leng XS, Wei JM, Liu LX, et al. Expert consensus on perioperative pain management in general surgery[J]. Chin J Gener Surg, 2015, 30(2): 166-173.
[38] Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review[J]. Anaesthesia, 2020, 75(): e101-e110.
[39] Angst MS, Drover DR. Pharmacology of drugs formulated with DepoFoam: a sustained release drug delivery system for parenteral administration using multivesicular liposome technology[J]. Clin Pharmacokinet, 2006, 45(12): 1153-1176.
[40] Hu D, Onel E, Singla N, et al. Pharmacokinetic profile of liposome bupivacaine injection following a single administration at the surgical site[J]. Clin Drug Investig, 2013, 33(2): 109-115.
[41] Patel MA, Gadsden JC, Nedeljkovic SS, et al. Brachial plexus block with liposomal bupivacaine for shoulder surgery improves analgesia and reduces opioid consumption: results from a multicenter, randomized, double-blind, controlled trial[J]. Pain Med, 2020, 21(2): 387-400.
[42] Weksler B, Sullivan JL, Schumacher LY. Randomi-zed trial of bupivacaine with epinephrine versus bupivacaine liposome suspension in patients under-going minimally invasive lung resection[J]. J Thorac Cardiovasc Surg, 2021, 161(5): 1652-1661.
[43] Chitty L, Ridley B, Johnson B, et al. Liposomal compared to 0.25% bupivacaine in patients under-going hemorrhoidectomy: a pre- and post-implementation quality improvement evaluation[J]. J Clin Anesth, 2022, 80: 110868.
[44] Kuang MJ, Du YR, Ma JX, et al. The efficacy of liposomal bupivacaine using periarticular injection in total knee arthroplasty: a systematic review and meta-analysis[J]. J Arthroplasty, 2017, 32(4): 1395-1402.
[45] Nadeau MH, Saraswat A, Vasko A, et al. Bupivacaine versus liposomal bupivacaine for postoperative pain control after augmentation mammaplasty: a prospective, randomized, double-blind trial[J]. Ae-sthet Surg J, 2016, 36(2): NP47-NP52.
[46] Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty[J]. J Arthroplasty, 2014, 29(8): 1687-1690.
[47] Lieblich SE, Danesi H. Liposomal bupivacaine use in third molar impaction surgery: INNOVATE study[J]. Anesth Prog, 2017, 64(3): 127-135.
[48] Iero PT, Mulherin DR, Jensen O, et al. A prospective, randomized, open-label study comparing an opioid-sparing postsurgical pain management protocol with and without liposomal bupivacaine for full-arch implant surgery[J]. Int J Oral Maxillofac Implants, 2018, 33(5): 1155-1164.
[49] Neal TW, Hammad Y, Schlieve T. Liposomal bu-pivacaine: a literature review of applications in oral and maxillofacial surgery[J]. J Oral Maxillofac Anesth, 2022, 1: 3.
[1] Bo Ma,Bowen Ke,Xinhua Liang. Progress in research on oral local anesthetics in the treatment of maxillofacial pain [J]. Int J Stomatol, 2025, 52(1): 82-91.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!