Effectiveness of two-stage versus one-stage injection in reducing discomfort during inferior alveolar nerve block in children

Abstract

Background: Inferior alveolar nerve block (IANB) anesthesia is a painful procedure & many attempts are made to render the injection painless, especially in children. Aim: To assess discomfort expressed during modified two-stage IANB injection versus one-stage injection in 8-10 years old children. Subjects & Methods: Sixty children were randomly & equally allocated to either intervention group (two-stage) or control group (one-stage). For all patients, topical anesthesia gel was applied. Intervention group: A short needle was used for the initial piercing & deposition of the local anesthesia (LA), the needle was inserted for 4mm & 0.4ml of the solution was deposited, then withdrawn. After 5 min, a long needle (gauge 27) was advanced till the point of LA drug deposition & bone touching & the rest of the LA solution was deposited. Control group: A long needle was inserted, dropping 0.4 ml of the solution incrementally till the point of LA drug deposition & bone touching & the rest of the LA solution was deposited. The overall patients’ levels of discomfort were assessed using Face Legs Activity Cry Consolability scale (FLACC) & Facial Image Scale (FIS). Results were tabulated & statistically analyzed. Results: For FLACC scale, the post-anesthetic values recorded a median=1 (range=0-3) in two-stages group, & a median=2 (range=0-4) in one-stage group; with statistically significant difference between them (p=0.00). For FIS, a median=2 (range=1-4) in the two-stage group & a median = 3 (range=1-5) in one-stage group; the difference between groups was statistically significant (p=0.017). Conclusion: The two-stage IANB injection technique is a simple & an effective method of reducing the overall discomfort in children.