Main Article Content
Abstract
RÉSUMÉ
INTRODUCTION. L’anesthésie locorégionale est très utilisée en odontostomatologie. Ses échecs peuvent avoir des causes multiples dont la connaissance et la correction peuvent contribuer à l’amélioration de la qualité de l’analgésie locorégionale en odontostomatologie. L’étude avait pour but d'identifier les facteurs étiologiques les plus importants dans notre pratique et leurs stratégies de prise en charge.
MÉTHODOLOGIE. Il s’agit d’une étude descriptive et prospective de quatre mois. Les patients ont été recrutés dans trois hôpitaux de Yaoundé. Était inclus tout patient ayant bénéficié d’une anesthésie locorégionale. Les données étaient recueillies à l’aide d’un questionnaire adressé au patient et au praticien. Les variables évaluées étaient la douleur, l’anxiété préopératoire, les informations sur l’anesthésie, l’anesthésique local utilisé et la prise en charge de l’échec d’anesthésie.
RÉSULTATS. Notre échantillon était de 252 patients. Les techniques les plus appliquées étaient les anesthésies para-apicale, régionale et intra-septale. Le taux d’échec était de 42,4%. Les facteurs associés aux échecs étaient : l’inflammation locale, l’anxiété, la technique para-apicale à la mandibule et l’absence de vasoconstricteurs. Les stratégies de prise en charge d’échec étaient : l’augmentation du temps de latence, l’augmentation de la dose d’anesthésique, l’application d’une technique de bloc à la mandibule et l’anesthésie intra-septale. Ces stratégies avaient permis une baisse du taux d’échec initial de 42,4%à 26%.
CONCLUSION. Les échecs d’anesthésie locorégionale sont un réel problème en odontostomatologie. Ils dépendent de plusieurs facteurs, qui doivent être recherchés.
MOTS CLÉS. Analgésie; Anesthésie locorégionale; Echec; Odontostomatologie
ABSTRACT
INTRODUCTION. Regional anesthesia is commonly used in mouth and dental medicine. In case of failure, knowledge and correction of the causal factors should improve the quality of regional anesthesia in dental medicine. The aim of the study was to identify the main etiological factors in case of failure of regional anesthesia and the strategies used to overcome them.
METHODS. We carried out a descriptive and prospective study during four months. Patients were enrolled in three hospitals of Yaoundé. The data were recorded with a questionnaire, which was addressed to patients and practitioners. The variables recorded were assessment of pain, preoperative anxiety, presence of inflammatory signs, anesthetic techniques, anesthetic drugs used and treatment of cases of failure.
RESULTS. We recruited 252 patients. The most commonly used technics were buccal infiltrations, nerve block and intra-septal anesthesia. The failure’s rate in regional anesthesia was 42.4%. Local inflammation, anxiety, buccal infiltration in mandible, absence of vasoconstrictors was associated with anesthetic failures. To treat these cases of failures, dental surgeons increased the interval time between the induction of anesthesia and dental care, increased the doses of drugs used, administered regional anesthesia on the mandible and used intra-septal anesthesia. We found a decrease in failure’s rates after these different measures from 42.4% to 26%.
CONCLUSION. Failures encountered with locoregional anesthesia remains a real problem in mouth and dental medicine. These failures depend on several factors which should be found and managed.
KEY WORDS. Analgesia – Regional anesthesia – Failure – Mouth and dental medicine
Article Details
References
- Garnier Delamare. Dictionnaire illustré des termes de médecine. Paris Maloine;2004.28:251p
- Hans Evers, Glenn Haegerstam. Manuel d’anesthésie locale dentaire. Milau: Dauwant S.A.; 1982.
- Gaudy J.F, Arreto C.D. manuel d’analgésie en odontostomatologie. Paris: Masson; 2005. 201 p.
- Rilliard F., Laurente. échecs d’anesthésie en endodontie. Rev Odontostomatol. Paris.1997; 26(2-3):103–14.
- Nusstein JM, Reader A, Drum M. Local Anesthesia Strategies for the Patient With a “Hot” Tooth. Dent Clin North Am. 2010 avril;54(2):237–47.
- Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod. 2012;38:421–5.
- Meechan JG. supplétary route to local anesthesia. Int Endod J. 2002;(35):885–96.
- Y. Jung, J.H. Kim, E.S. Kim, et al. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod. 2008;34:11–3.
- Mason R, Drum M, Reader A, et al. A prospective, randomized, double-blind comparsion of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine for maxillary infiltrations. J Endod. 2009;35:1173–7.
- Shahriar Shahi, Hadi Mokhtari, Saeed Rahimi, Hamid Reza Yavari, Shima Narimani, et al. Effect of Premedication with Ibuprofen and Dexamethasone on Success Rate of Inferior Alveolar Nerve Block for Teeth with Asymptomatic Irreversible Pulpitis: A Randomized Clinical Trial. J Endod. 2013 février;39(2):160–2.
- Matthews R, Drum M M, Reader A, et al. articaine for suplémental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior nerve block fails. J Endod. 2009;35(3):343–6.
- John G. Meechan. Infiltration Anesthesia in the Mandible. Dent Clin North Am. 2010;54(4):621–9.
- M Batt, C Cornet. anxiété préopératoire et analgesie controlée par le patient en période post opératoire. douleurs. 2004;5:3524.
- Mike T. John. In patients attending general dental practices, is dental anxiety associated with pain experienced during dental procedures? Community Dent Oral Epidemiol. 2012 Aug;40(4):343–50.
- Ogle OE, Mahjoubi G. Local Anesthesia: Agents, Techniques, and Complications. Dent Clin North Am. 2012 Jan;56(1):133–48.
- Berlin J, Nusstein J, Reader A. Efficacy of articaine and lidocaine in a primary intraligamentary injection with a computer controlled local anaesthésia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2005;99:361–6.
References
Garnier Delamare. Dictionnaire illustré des termes de médecine. Paris Maloine;2004.28:251p
Hans Evers, Glenn Haegerstam. Manuel d’anesthésie locale dentaire. Milau: Dauwant S.A.; 1982.
Gaudy J.F, Arreto C.D. manuel d’analgésie en odontostomatologie. Paris: Masson; 2005. 201 p.
Rilliard F., Laurente. échecs d’anesthésie en endodontie. Rev Odontostomatol. Paris.1997; 26(2-3):103–14.
Nusstein JM, Reader A, Drum M. Local Anesthesia Strategies for the Patient With a “Hot” Tooth. Dent Clin North Am. 2010 avril;54(2):237–47.
Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod. 2012;38:421–5.
Meechan JG. supplétary route to local anesthesia. Int Endod J. 2002;(35):885–96.
Y. Jung, J.H. Kim, E.S. Kim, et al. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod. 2008;34:11–3.
Mason R, Drum M, Reader A, et al. A prospective, randomized, double-blind comparsion of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine for maxillary infiltrations. J Endod. 2009;35:1173–7.
Shahriar Shahi, Hadi Mokhtari, Saeed Rahimi, Hamid Reza Yavari, Shima Narimani, et al. Effect of Premedication with Ibuprofen and Dexamethasone on Success Rate of Inferior Alveolar Nerve Block for Teeth with Asymptomatic Irreversible Pulpitis: A Randomized Clinical Trial. J Endod. 2013 février;39(2):160–2.
Matthews R, Drum M M, Reader A, et al. articaine for suplémental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior nerve block fails. J Endod. 2009;35(3):343–6.
John G. Meechan. Infiltration Anesthesia in the Mandible. Dent Clin North Am. 2010;54(4):621–9.
M Batt, C Cornet. anxiété préopératoire et analgesie controlée par le patient en période post opératoire. douleurs. 2004;5:3524.
Mike T. John. In patients attending general dental practices, is dental anxiety associated with pain experienced during dental procedures? Community Dent Oral Epidemiol. 2012 Aug;40(4):343–50.
Ogle OE, Mahjoubi G. Local Anesthesia: Agents, Techniques, and Complications. Dent Clin North Am. 2012 Jan;56(1):133–48.
Berlin J, Nusstein J, Reader A. Efficacy of articaine and lidocaine in a primary intraligamentary injection with a computer controlled local anaesthésia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2005;99:361–6.