Current sedation practice in Israel.
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Anesthesia, Dental↗
Biomedical subjects
Eliezer Kaufman
Publications and source records attributed to Eliezer Kaufman.
A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections.
Intraoral local anesthesia is essential for delivering dental care. However, it is often perceived by some patients as the most painful and in some instances as the only painful part of the treatment, leading in extreme cases to avoidance of dental care. The present study measured the variables of pain, pressure, and discomfort caused by 4 commonly used local anesthesia injections: local infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament injections. Patients were asked to grade pain, discomfort, and pressure on a visual analog scale as associated with needle insertion, operator finger position in the mouth, and pressure at injection. The inferior alveolar injection was graded to be the most painful followed by periodontal ligament and then mental nerve block injections. The periodontal ligament injections yielded the highest pressure scores. The inferior alveolar block injection yielded significantly more discomfort than local infiltration and mental nerve block injections when comparing finger and needle position. Local infiltration in the anterior maxillary region yielded the highest needle insertion and finger position discomfort scores. The present study suggests that the dental operator should be aware of local anesthesia injection pain, pressure, and discomfort together with efficacy of technique.
Adolescent↗
Preemptive analgesia and local anesthesia as a supplement to general anesthesia: a review.
General anesthesia (GA) and local anesthesia (LA) evolved on separate tracks. Procedures that could not be performed under LA were typically conducted under GA. Decoding of afferent linkage of peripheral noxious stimuli has provided important understanding that may change the way we traditionally treat surgical pain. In the 1980s, animal studies suggested that preemptive peripheral blocking of painful (nociceptive) stimuli to the central nervous system with regional anesthesia or LA and nonsteroidal analgesics could be beneficial in attenuating postoperative pain. Clinical studies based on this knowledge suggest combining LA with GA, and perhaps non-steroidal analgesics with or without narcotics, to reduce the severity of postoperative pain. General anesthetics can be given in lower minimal alveolar concentration when combined with LA, and recovery characteristics are superior. Increasing evidence suggests that the combined use of GA and LA may reduce the afferent barrage of surgery, and that preemptive analgesia may reduce postoperative pain and should be used in patient care. This article reviews the evidence supporting the combined use of LA or analgesics with GA or sedation to provide improved pain management after surgery.
Analgesia↗
The influence of sequence of impressions on children's anxiety and discomfort.
PURPOSE: Laboratory studies with adults and children have found lower pain reports when pain proceeds from high to low rather than from low to high. However, pediatric dentists often ease children into difficult procedures (from easiest to most difficult). This study investigated the influence of order during a clinical procedure that involved taking maxillary and mandibular alginate impressions. METHODS: Subjects were 24 children aged 5 to 6 years (preoperational stage) and 24 children aged 9 to 10 years (concrete operational stage). Children were randomly assigned to either start with the mandibular (presumed to be easier) or start with the maxillary (presumed to be harder) impressions. Discomfort during the sequence of impressions was measured using the "Affective Facial Scale." A telephone interview was conducted 2 weeks later to evaluate the memory of discomfort. RESULTS: The results indicated that the older children who started with the mandibular (easier) impression and ended with the maxillary (more uncomfortable) impression reported significantly lower discomfort than older children who started with the maxillary impression and ended with the mandibular (Mann-Whitney U, Z = -2.08; P < .037). The same tendency was noted 2 weeks later on a telephone interview. By phone, 92% of the older children who started with the mandibular impression rated the sequence of impressions as "not at all bad," while only 58% of the older children who started with the maxillary impression rated the overall experience as "not at all bad" (chi2 = 3.56, P < .059). The younger children did not show any significant difference in their ratings of discomfort at either of the assessment periods. CONCLUSIONS: Consistent with clinical practice, this study observed that older children benefit from beginning an appointment with an easier procedure and working up to a more difficult one.
Alginates↗