J Korean Assoc Oral Maxillofac Surg.  2022 Feb;48(1):21-32. 10.5125/jkaoms.2022.48.1.21.

Effectiveness of dexamethasone or adrenaline with lignocaine 2% for prolonging inferior alveolar nerve block: a randomized controlled trial

• Deo SP
• Ahmad MS
• Singh A

• KMID: 2526807
• DOI: http://doi.org/10.5125/jkaoms.2022.48.1.21

Abstract

Objectives
Inferior alveolar nerve block (IANB) is commonly used for mandibular dentoalveolar surgery. The objective of this study was to evaluate and compare the effectiveness of coadministration of dexamethasone (4 mg/mL) or adrenaline (0.01 mg/mL) as an adjuvant with lignocaine 2% in IANB during third molar surgery (TMS).
Patients and Methods
This double-blind, randomized controlled trial was conducted between March and August 2020. The investigators screened patients needing elective TMS under local anesthesia. Based on strict inclusion and exclusion criteria, patients were enrolled in this study. These patients were assigned randomly into two study groups: dexamethasone group (DXN) or adrenaline group (ADN). Outcome variables were postoperative edema, trismus, visual analogue scale (VAS), perioperative analgesia, onset time, and duration of IANB.
Results
Eighty-three patients were enrolled in this study, of whom 23 (27.7%) were eliminated or excluded during follow-up. This study thus included data from 60 samples. Mean age was 32.28±11.74 years, including 28 females (46.7%) in the ADN (16 patients, 57.1%) and DXN (12 patients, 42.9%) groups. The duration of action for DXN (mean±standard deviation [SD], 4:02:07±0:34:01 hours; standard error [SE], 0:06:00 hours; log-rank P=0.001) and for ADN (mean±SD, 1:58:34±0:24:52 hours; SE, 0:04:42 hours; log-rank P=0.001) were found. Similarly, time at which 1st analgesic consume and total number of nonsteroidal antiinflammatory drugs need to rescue postoperative analgesia was found statistically significant between study groups (t (58)=–11.95; confidence interval, –2:25:41 to –1:43:53; P=0.001). Early-hours VAS was also significantly different between the study groups.
Conclusion
A single injection of dexamethasone prolongs the duration of action of lignocaine 2% IANB. Additionally, it can be used in cases where adrenaline is contraindicated.

Keyword

Dexamethasone; Inferior alveolar nerve; Nerve block; Lidocaine; Third molar

Figure

• 

  Fig. 1 CONSORT (Consolidated Standards of Reporting Trials) diagram; flow chart detailing patient’s recruitment and flow-up in this study. (DXN: dexamethasone, IANB: inferior alveolar nerve block, ADN: adrenaline)

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  Fig. 2 A. Onset time of anaesthesia; subjective and objective assessment of pain by asking the patient felling lip and tongue numbness and pain perception of palpating with blunt instrument at different regions between groups. B. Duration of inferior alveolar nerve block (IANB); subjective and objective assessment of pain by asking the patient loss of lip and tongue numbness and regain of pain perception of palpating with blunt instrument at different regions between groups. (ADN: adrenaline, DXN: dexamethasone)

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  Fig. 3 Mean visual analogue scale (VAS) response with standard deviation of first 27 hours after third molar surgery. P≤0.05 is the statistically significant. 1st hour profound anesthesia in both groups. VAS is slightly rising up to 4 hours due to prolongation of IANB in dexamethasone (DXN). (ADN: adrenaline)

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  Fig. 4 Hemodynamic change after injection; intraoperative and postoperative vitals were statistically same with preoperative vitals in both groups. (DXN: dexamethasone, ADN: adrenaline, HR: heart rate, RR: respiratory rate, BP: blood pressure)

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  Fig. 5 Postoperative recovery from third molar surgery sequalae; left side, 2nd and 7th day reduction of facial contour from baseline in mm and right side, 2nd and 7th day reduced IIO from normal mouth opening in mm. Postoperative swelling was statistically significantly reduced in 2nd postoperative day in dexamethasone (DXN). *P≤0.05 is statistically significant. (ADN: adrenaline, POD: postoperative day)

• 

  Fig. 6 Neuro-anatomy of inferior alveolar nerve; cable wire network of neurons surrounds by the endoneurium in central (core) and periphery (mental) fibers, wrapped into the perineurium and epineurium diffusion of local anaesthetic solution from the mantle to core fibers.

Reference

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