Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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Comparative efficacy of 5% EMLA cream and 20% Benzocaine gel during topical anesthesia

5% EMLA cream과 20% Benzocaine gel의 도포마취 효능 비교

  • Lee, Dae-Woo (Department of Pediatric Dentistry, School of Dentistry, Chonbuk National University) ;
  • Baik, Byeong-Ju (Department of Pediatric Dentistry, School of Dentistry, Chonbuk National University) ;
  • Kim, Jae-Gon (Department of Pediatric Dentistry, School of Dentistry, Chonbuk National University) ;
  • Yang, Yeon-Mi (Department of Pediatric Dentistry, School of Dentistry, Chonbuk National University) ;
  • So, Yu-Ryeo (Department of Pediatric Dentistry, School of Dentistry, Chonbuk National University)
  • 이대우 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 백병주 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 김재곤 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 양연미 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 소유려 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소)
  • Received : 2010.12.31
  • Accepted : 2011.01.31
  • Published : 2011.02.28
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Abstract

The objective of this study was to determine the effectiveness of topical 5% EMLA cream versus 20% Benzocaine gel in reducing pain from intra oral needle insertion alone as well as injection of anesthetic. The 2 topical anesthetics were tested against each other bilaterally using a randomized, controlled, single blinded, split mouth design. Phase I was conducted to find out the rapidity of onset action of the two agents on anterior/posterior vestibules and anterior/posterior palatal mucosa. Phase II was conducted to evaluate the efficacy of the two topical anaesthetic agents in reducing the pain of intraoral injections. The agents were left in anterior/posterior vestibules and anterior/posterior palatal mucosa for the amount of time recorded in phase I. Subjects recorded pain on a 100-mm modified visual analog scale(VAS). A pulse oximeter was used to recorded the preoperative and postoperative pulse rates. In phase I of the study, two topical agents showed the longer onset of action at anterior part and vestibules than posterior part and palatal mucosa. EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. In phase II of the study, the VAS grading of the pain for anesthetic administration showed EMLA cream was significantly(P<.05) better in elimination or reducing the pain on the anterior/posterior palatal mucosa. In conclusion, EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. EMLA cream was found to be superior to Benzocaine gel with regards to pain reduction for anesthetic administration especially on anterior and posterior palatal mucosa.

이 연구의 목적은 도포마취제로서 5% EMLA cream과 20% Benzocaine gel의 구강 내 주사침 자입 및 마취제 주입시 전/구치부 전정부와 구개부에서의 작용시간과 동통 감소 효과를 평가하기 위함이다. 두 가지 도포마취제는 양측성 무작위 단일 맹검법 분할 디자인으로 평가되었다. Phase I은 전/구치부 전정부와 구개부에 도포마취제를 도포한 후 각각의 도포마취제의 작용시간을 평가하였다. Phase II는 Phase I에서 측정된 시간을 기초로 각각의 도포마취제를 부위별로 적용하여 주사침 자입 및 마취제 주입시 동통 감소 효과를 평가하였다. 평가를 위해 100-mm modified visual analog scale(VAS)를 이용하여 주관적인 동통 수치를 기록하였고, 맥박산소측정기(Pulse oximeter)를 사용하여 주사침 자입 및 마취제 주입 전후의 맥박수를 관찰하여 객관적인 동통 감소 효과를 비교하였다. Phase I 실험결과 두 가지 도포마취제는 전치부가 구치부보다, 구개부가 전정부보다 더 긴 작용시간을 보였다. 전치부 구개부를 제외한 모든 부위에서 EMLA cream이 Benzocaine gel보다 더 빠른 작용시간을 보였다. Phase II 실험결과 마취제주입시 부위별 그룹에 따른 VAS Score를 보면 전치부와 구치부 구개부에서 EMLA cream이 Benzocaine보다 동통 감소 효과에 있어 유의한 차이를 보였다(p<.05). 결론적으로 EMLA cream은 Benzocaine보다 전정부와 구개부 모두에서 빠른 작용시간과 더 좋은 유지력을 나타냈다. 또한 EMLA cream은 Benzocaine보다 주사침 자입시 전치부 구개부를 제외한 모든 부위에서, 마취제 주입시 전치부와 구치부 구개부에서 Benzocain 에 비해 더 좋은 동통 감소 효과를 보였다.

Keywords

References

  1. Baghdadi DZ : Evaluation of electronic dental anaesthesia in children. Oral Surg Oral Med Oral Pathol Oral RadiolEndod, 88:418-423, 1999. https://doi.org/10.1016/S1079-2104(99)70055-7
  2. Asarch T, Allen K, Petersen B, Beiraghi S : Efficacy of a computerized local anesthesia device in pediatric dentistry. Pediatr Dent, 21:421-424, 1999.
  3. 김희진, 고승백, 홍성수 등. : 소아에서 EMLA 크림을 이 용한 도포마취: 증례보고. 대한소아치과학회지, 29(1): 69-75, 2002.
  4. Campbell AH, Stasse JA, Lord GH, Nilson JE : In vivo evaluation of local anaesthetic applied topically. JPharm-Sci, 57:2045-2048, 1968. https://doi.org/10.1002/jps.2600571204
  5. 김규식, 김명진 : 치과국소마취학. 지성출판사, 1991.
  6. Vickers ER, Punnia Moorthy A : A clinical evaluation of three topical anaesthetic agents. Aust Dent J, 37(4):266-270, 1992. https://doi.org/10.1111/j.1834-7819.1992.tb04742.x
  7. Cavino BG : Pharmacology of local anaesthetic agents. BrJAnaest, 58:701, 1986.
  8. 이재춘, 김대업, 이광희 외 : 분사식 주사기를 이용한 소아 환자의 국소마취. 대한소아치과학회지, 28(4):633-637, 2001.
  9. Tulga F, Mutlu Z : Four types of topical anaesthetic agents: evaluation of clinical effectiveness. J Clin Pediatr Dent, 23(3):217-220, 1999.
  10. Gill C, Orr D : A double-blinded crossover comparison of topical anesthetics. JADA, 98:213-214, 1979.
  11. Yaacob H, Noor G, and Malek S : The pharmacological effect of xylocaine topical anesthetic-A comparison with a placebo. Singapore Dent J, 6:55-57, 1981.
  12. Svensson P, Peterson JK : Anesthetic effect of EMLA occluded with orahesive oral bandages an oral mucosa, A placebo controlled study. Anesth Prog, 39(3):79-82, 1992.
  13. Juhlin L, Evers H, Broberg F : A lidocaine-prilocaine cream for superficial skin surgery and painful lesions. Acta Derm Venereol, 60:544-546, 1980.
  14. Holst A, Evers H : Experimental studies of new topical anaesthetics on the oral mucosa. Swed Dent J, 9:185-191, 1985.
  15. Haasio J, Jokinen T, Numminen P, et al. : Topical anaesthesia of gingival mucosa by 5% eutectic mixture of lignocaine and prilocaine or by 10% lignocaine spray. Br J Oral Maxillofac Surg, 28:99-101, 1990. https://doi.org/10.1016/0266-4356(90)90131-4
  16. Rosivack RG, Koenigsberg SR, Maxwell KC : An analysis of the effectiveness of two topical anaesthetics. Anesth Prog, 37(6):290-292, 1990.
  17. Pere P, Lizuka T, Rosenberg PH, et al. : Topical application of 5% eutectic mixture of lignocaine and prilocaine (EMLA) before removal of arch bars. Br J Oral Maxillofac Surg, 30(3):153-6, 1992. https://doi.org/10.1016/0266-4356(92)90146-A
  18. Vickers ER, Punnia Moorthy A : Pulpal anaesthesia from an application of a eutectic topical anesthetic. Quintessence lnt, 24(8):547-551, 1993.
  19. Meechan JG, Donaldson D : The intra oral use of EMLA cream in children: A clinical investigation. ASDC J Dent Child, 61(4):260-262, 1994.
  20. Svensson P, Petersen JK. Svensson H : Efficacy of a topical anaesthetic on pain and unpleasentness during scaling gingival pockets. Anesth Prog, 41(2):35-39, 1994.
  21. Meechan JG, Winter RA : A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra oral injections. Br Dent J, 181(9):333-335, 1996. https://doi.org/10.1038/sj.bdj.4809252
  22. Meechan JG, Thomason JM : A comparison of 2 topical anaesthetics on the discomfort of intraligamentary injections, A double-blind, split mouth volunteer clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 87:362-365, 1999. https://doi.org/10.1016/S1079-2104(99)70224-6
  23. Roghani S, Duperon DF, Barcohana N : Evaluating the efficacy of commonly used topical anaesthetics. PediatrDent, 21(3):197-200, 1999.
  24. Nayak R, Sudha P : Evaluation of three topical anaesthetic agents against pain: a clinical study. Indian J Dent Res, 17(4):155-60, 2006. https://doi.org/10.4103/0970-9290.29871
  25. Huskinson EC : Measurement of pain. Lancet, 1127-1131, 1974.
  26. Krane JE, Tyler DC : Post operative pain management in children. Anaesth Clin North America, 7(1):159-160, 1989.
  27. Huskinson EC : Visual analogue scales. In Melzack R: Pain measurement and assessment. New York Raven, Press; 33-37, 1983.
  28. Wright GZ, Marti R, Weinberger SJ : The effectiveness of infiltration anaesthesia in the mandibular primary molar region. Pediatr Dent, 13:278-283, 1991.
  29. Meechan JG, Webery RR : Oral Surgery for children: 2: Anaesthesia and sedation, Dental Update 206-212, 1993.
  30. American Dental Association Council On Dental Therapeutics : Accepted dental therapeutics, Chicago 1984, The American Dental Association sited in Stanley F. Malamed: Hand book of local Anaesthesia, (4th Ed), Mosby; 304, 1997.
  31. Book A, Fehlandt C, Krija M, et al. : Methemoglobin intoxication by prilocaine in EMLA. Accidental intoxication of an infant with scald injuries. Anaesthesist. 2009 Apr;58(4):370-4. German. https://doi.org/10.1007/s00101-009-1512-5
  32. Chung NY, Batra R, Itzkevitch M, et al. : Severe methemoglobinemia linked to gel-type topical benzocaine use: a case report. J Emerg Med. 2010 Jun;38(5):601-6. Epub. 2008 Dec 20. https://doi.org/10.1016/j.jemermed.2008.06.025
  33. Balicer RD, Kitai E : Methemoglobinemia caused by topical teething preparation: a case report. Scientific World Journal, Jul 15;4:517-20, 2004. https://doi.org/10.1100/tsw.2004.109
  34. Parker JF, Vats A, Bauer G. : EMLA toxicity after application for allergy skin testing. Pediatrics, 113(2): 410-1, 2004 Feb. https://doi.org/10.1542/peds.113.2.410
  35. Raso SM, Fernandez JB, Beobide EA, et al. : Methemoglobinemia and CNS toxicity after topical application of EMLA to a 4-year-old girl with molluscum contagiosum. Pediatr Dermatol, 23(6):592-3, 2006 Nov-Dec. https://doi.org/10.1111/j.1525-1470.2006.00319.x
  36. Bagesund M, Tabrizi P. : Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa. Int J Paediatr Dent, 18(6):452-60, Epub 2008 Mar 12. https://doi.org/10.1111/j.1365-263X.2007.00910.x