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Comparação entre a técnica local infiltrativa e locoregional para anestesia dos molares mandibulares
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Abstract(s)
A invenção da anestesia teve um impacto revolucionário na medicina. No século XVI, o cirurgião francês Ambroise Paré utilizou álcool e ópio para aliviar a dor dos pacientes. Em 1884, químicos descobriram a primeira anestesia local; a aplicação de cocaína por meio de injeção. Em 1943, os químicos Nils Löfgren e Bengt Lundquist propuseram o uso da lidocaína como anestésico local, uma técnica que ainda é amplamente empregada em medicina.
Os anestésicos locais são os medicamentos mais utilizados na medicina dentária. Estima-se que um dentista utilize, em média, 1.500 anestubos por ano. No entanto, a técnica de infiltração local com lidocaína apresenta limitações em certas áreas da cavidade oral, como a região posterior da mandíbula, onde o osso cortical mais espesso dificulta a difusão adequada da anestesia. Nessas situações, recorre-se à técnica de anestesia locorregional, que consiste na injeção próxima ao tronco nervoso principal, bloqueando a condução nervosa nos ramos colaterais e terminais.
Mas a anestesia locorregional apresenta mais riscos, tais como uma injeção inadequada de anestésicos devido ao posicionamento inadequado da agulha, injeção intravascular, resultando em hematoma, lesão nervosa. Um estudo revelou uma taxa de falha de 20-25% no bloqueio do nervo alveolar inferior. Diante disso, surgiu uma alternativa: o uso de anestesia local infiltrativa com a articaína, uma molécula de maior
potencial anestésico. A articaína, sintetizada pela primeira vez em 1969, possui uma estrutura química diferente da lidocaína, o que aumenta sua solubilidade lipídica, proporcionando um início de ação mais prolongado e uma toxicidade reduzida para o paciente, permitindo o aumento da dose durante a cirurgia.
O objetivo deste trabalho é comparar a eficácia, as vantagens e as desvantagens das técnicas de anestesia local infiltrativa e locorregional para anestesiar os molares mandibulares. Serão avaliados os resultados presentes na literatura em relação à dor no local da injeção, tempo de latência da anestesia, quantidade de anestésico necessário e complicações associadas a cada técnica.
The invention of anesthesia had a revolutionary impact on medicine. In the 16th century, French surgeon Ambroise Paré used alcohol and opium to relieve patients' pain. In 1884, chemists discovered the first local anesthesia, the application of cocaine through injection. In 1943, chemists Nils Löfgren and Bengt Lundquist proposed the use of lidocaine as a local anesthetic, a technique that is still widely employed in medicine. Local anesthetics are the most commonly used medications in dentistry. It is estimated that a dentist uses an average of 1,500 anesthetic cartridges per year. However, the technique of local infiltration with lidocaine has limitations in certain areas of the oral cavity, such as the posterior region of the mandible, where the thicker cortical bone hinders proper diffusion of the anesthesia. In these situations, the locoregional anesthesia technique is used, which involves injecting near the main nerve trunk, blocking nerve conduction in collateral and terminal branches. However, locoregional anesthesia presents more risks, such as an inadequate injection of anesthetics due to improper needle placement, intravascular injection resulting in hematoma, or nerve injury. A study revealed a failure rate of 20-25% in inferior alveolar nerve blocks. In light of this, an alternative emerged: the use of infiltrative local anesthesia with articaine, a molecule with higher anesthetic potential. Articaine, first synthesized in 1969, has a different chemical structure from lidocaine, which increases its lipid solubility, providing a longer onse of action and reduced toxicity for the patient, allowing for increased dosage during surgery. The aim of this study is to compare the effectiveness, advantages, and disadvantages of infiltrative local anesthesia and locoregional anesthesia techniques for anesthetizing mandibular molars. The literature will be evaluated regarding pain at the injection site, anesthesia latency time, amount of anesthetic required, and complications associated with each technique.
The invention of anesthesia had a revolutionary impact on medicine. In the 16th century, French surgeon Ambroise Paré used alcohol and opium to relieve patients' pain. In 1884, chemists discovered the first local anesthesia, the application of cocaine through injection. In 1943, chemists Nils Löfgren and Bengt Lundquist proposed the use of lidocaine as a local anesthetic, a technique that is still widely employed in medicine. Local anesthetics are the most commonly used medications in dentistry. It is estimated that a dentist uses an average of 1,500 anesthetic cartridges per year. However, the technique of local infiltration with lidocaine has limitations in certain areas of the oral cavity, such as the posterior region of the mandible, where the thicker cortical bone hinders proper diffusion of the anesthesia. In these situations, the locoregional anesthesia technique is used, which involves injecting near the main nerve trunk, blocking nerve conduction in collateral and terminal branches. However, locoregional anesthesia presents more risks, such as an inadequate injection of anesthetics due to improper needle placement, intravascular injection resulting in hematoma, or nerve injury. A study revealed a failure rate of 20-25% in inferior alveolar nerve blocks. In light of this, an alternative emerged: the use of infiltrative local anesthesia with articaine, a molecule with higher anesthetic potential. Articaine, first synthesized in 1969, has a different chemical structure from lidocaine, which increases its lipid solubility, providing a longer onse of action and reduced toxicity for the patient, allowing for increased dosage during surgery. The aim of this study is to compare the effectiveness, advantages, and disadvantages of infiltrative local anesthesia and locoregional anesthesia techniques for anesthetizing mandibular molars. The literature will be evaluated regarding pain at the injection site, anesthesia latency time, amount of anesthetic required, and complications associated with each technique.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Anestesia Molares mandibulares Infiltrativa Loco regional