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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 51 -55. doi: 10.3877/cma.j.issn.1674-1366.2019.01.010

所属专题： 口腔医学； 文献；

综述

局部麻醉药物在儿童口腔诊疗中的应用
韩欣欣1, 汪璐璐1, 王子瑞1, 赵辛1, 王小竞1,†()   
  1. 1. 第四军医大学口腔医院儿童口腔科，陕西省口腔疾病临床医学研究中心，国家口腔疾病临床医学研究中心，军事口腔医学国家重点实验室，西安　710032
  • 收稿日期:2018-12-20 出版日期:2019-02-01
  • 通信作者: 王小竞

Application of local anesthetics in pediatric dentistry

Xinxin Han1, Lulu Wang1, Zirui Wang1, Xin Zhao1, Xiaojing Wang1,†()   

  1. 1. The Fourth Military Medical University, School of Stomatology, Department of Pediatric Dentistry, Shanxi Clinical Research Center for Oral Diseases & National Clinical Research Center for Oral Diseases State & Key Laboratory of Military Stomatology, Xi′an 710032, China
  • Received:2018-12-20 Published:2019-02-01
  • Corresponding author: Xiaojing Wang
  • About author:
    Corresponding author: Wang Xiaojing, Email:
  • Supported by:
    The Natural Science Foundation of China(81670988, 81500805)
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韩欣欣, 汪璐璐, 王子瑞, 赵辛, 王小竞. 局部麻醉药物在儿童口腔诊疗中的应用[J]. 中华口腔医学研究杂志(电子版), 2019, 13(01): 51-55.

Xinxin Han, Lulu Wang, Zirui Wang, Xin Zhao, Xiaojing Wang. Application of local anesthetics in pediatric dentistry[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(01): 51-55.

无痛及舒适化诊疗等技术的提出，使局部麻醉药物在临床的应用更加广泛，尤其是在儿童口腔诊疗中的应用。儿童生长发育与成人存在较大的生理差异，在疼痛控制和局部麻醉药物的应用与成人不同。本文就国内外学者关于各类局部麻醉药物在儿童口腔局部麻醉应用中的系统毒性、最大推荐剂量以及舒适化麻醉方法进行综述，旨在为儿童口腔医生临床应用局部麻醉药物提供帮助。

关键词: 儿童口腔医学, 麻醉药，局部, 最大耐受剂量, 患者舒适, 局部麻醉系统毒性

The introduction of techniques such as painless and comfortable treatment has made the application of local anesthetics more widely in clinical practice, especially in pediatric dental treatment. Children′s growth and development have important physiological differences with adults, and the application of pain control and local anesthetic drugs is different from that of adults. This review focuses on the systemic toxicity of local anesthesia in children, the maximum recommended dose and the comfortable methods of anesthesia, which aims at providing pediatric dentists with some guides.

Key words: Pediatric dentistry, Anesthetics, local, Maximum tolerated dose, Patient comfort, Local anesthetic systemic toxicity
表1 常用口腔局部麻醉药物的最大推荐剂量及特性[18]
药剂 浓度（mg/mL） 最大推荐剂量（MRD） （mg/kg） 最大推荐体积（mL/kg） 最大总剂量（mg） 神经毒性a 过敏反应 备注说明
利多卡因 20 4.4 0.22 300 中 有 用于3岁以下儿童，推荐0.25%不含肾上腺素的利多卡因
2%甲哌卡因+1∶10万肾上腺素 20 4.4（1.33） 0.22（0.025） 300 小 罕见 用于3岁以上儿童
3%甲哌卡因 30 4.4（1.33） 0.147（0.025） 300 小 罕见 3岁以下儿童禁用（3 ~ 6岁用量：1.1 ~ 2.2 mL；6 ~ 14岁用量：1.6 ~ 3.3 mL）
4%阿替卡因+1∶10万肾上腺素 40 7.0（5.0） 0.175（0.125） 500 小 少 用于4岁以上儿童
[1]
Salem K, Kousha M, Anissian A，et al. Dental fear and concomitant factors in 3-6 year-old children[J]. Dent Res Dent Clin Dent Prospects，2012，6(2):70-74. DOI：10.5681/joddd.2012.015.
[2]
Cianetti S, Lombardo G, Lupatelli E，et al. Dental fear/anxiety among children and adolescents. A systematic review[J]. Eur J Pediatr Dent，2017，18(2):121-130. DOI：10.23804/ejpd.2017.18.02.07.
[3]
Olak J, Saag M, Honkala S，et al. Children′s dental fear in relation to dental health and parental dental fear[J]. Stomatologija，2013，15(1):26-31.
[4]
Saraghi M, Moore PA, Hersh EV. Local anesthetic calculations：avoiding trouble with pediatric patients[J]. Gen Den，2015，63(1):48-52.
[5]
Mayor-Subirana G, Yagüe-García J, Valmaseda-Castellón E，et al. Anesthetic efficacy of Oraqix® versus Hurricaine® and placebo for pain control during non-surgical periodontal treatment[J]. Med Oral Patol Oral Cir Bucal，2014，19(2):e192-e201. DOI：10.4317/medoral.19202.
[6]
Donaldson M, Goodchild JH. Lidocaine turns 70：the evolution of dental local anesthesia[J]. Gen Dent，2018，66(3):6-9.
[7]
Bagesund M, Tabrizi P. Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa[J]. Int J Paediatr Dent，2008，18(6):452-460. DOI：10.1111/j.1365-263X.2007.00910.x.
[8]
Al-Dosary K, Al-Qahtani A, Alangari A. Anaphylaxis to lidocaine with tolerance to articaine in a 12 year old girl[J]. Saudi Pharm J，2014，22(3):280-282. DOI：10.1016/j.jsps.2013.10.001.
[9]
To D, Kossintseva I, de Ganners G. Lidocaine contact allergy is becoming more prevalent[J]. Dermatol Surg，2014，40(12):1367-1372. DOI：10.1097/DSS.0000000000000190.
[10]
Leith R, Lynch K, O′Connell AC. Articaine use in children：a review[J]. Eur Arch Paediatr Dent，2012，13(6):293-296. DOI：10.1007/BF03320829.
[11]
Sharma V, Harper NJ, Garcez T，et al. Allergic reaction to mepivacaine in a child[J]. Br J Anaesth，2013，110(6):1059-1060. DOI：10.1093/bja/aet147.
[12]
Chin KL, Yagiela JA, Quinn CL，et al. Serum mepivacaine concentrations after intraoral injection in young children[J]. J Calif Dent Assoc，2003，31(10):757-764.
[13]
Lee HS. Recent advances in topical anesthesia[J]. J Dent Anesth Pain Med，2016，16(4):237-244. DOI：10.17245/jdapm.2016.16.4.237.
[14]
Hersh EV, Helpin ML, Evans OB. Local anesthetic mortality：report of case[J]. ASDC J Dent Child，1991，58(6):489-491.
[15]
Zinman EJ. More on mepivacaine[J]. J Calif Dent Assoc，1976，4(4):50.
[16]
Haas DA. An update on local anesthetics in dentistry[J]. J Can Dent Assoc，2002，68(9):546-551.
[17]
Moore PA, Hersh EV. Local anesthetics：pharmacology and toxicity[J]. Dent Clin North Am，2010，54(4):587-599. DOI：10.1016/j.cden.2010.06.015.
[18]
Council on Clinical Affairs, American Academy of Pediatric Dentistry. Guideline on use of local anesthesia for pediatric dental patients[J]. Pediatr Dent，2015，37(5):71-77.
[19]
Scott DB, Jebson PJ, Braid DP，et al. Factors affecting plasma levels of lignocaine and prilocaine[J]. Br J Anaesth，1972，44(10):1040-1049.
[20]
Malamed S. Pharmacology of vasopressors. In：Malamed S，ed. Handbook of Local Anesthesia[M]. 6th ed. St. Louis，Mo.，USA：Elsevier/Mosby，2013：39-51.
[21]
Cheatham BD, Primosch RE, Courts WJ. A survey of local anesthetic usage in pediatric patients by Florida dentists[J]. ASDC J Dent Child，1992，59(6):401-407.
[22]
Moore PA, Hersh EV. Local anesthetics：pharmacology and toxicity[J]. Dent Clin North Am，2010，54(4):587-599. DOI：10.1016/j.cden.2010.06.015.
[23]
Williams D, Splaver T, Walker J. A nomogram for calculation of maximum recommended dose by volume of local anesthetic in pediatric dentistry[J]. Pediatr Dent，2017，39(2):150-154.
[24]
Abu Al-Melh M, Andersson L, Behbehani E. Reduction of pain from needle stick in the oral mucosa by topical anesthetics：a comparative study between lidocaine/prilocaine and benzocaine [J]. J Clin Dent，2005，16(2):53-56.
[25]
Nayak R, Sudha P. Evaluation of three topical anaesthetic agents against pain：a clinical study[J]. Indian J Dent Res，2006，17(4):155-160. DOI：10.4103/0970-9290.29871.
[26]
Ramacciato JG, Meechan JG. Recent advances in local anaesthesia[J]. Dent Update，2005，32(1):8-14.
[27]
Melzack R, Wall PD. Pain mechanisms：a new theory[J]. Science，1965，150(3699):971-979.
[28]
Saxena P, Gupta SK, Newaskar V，et al. Advances in dental local anesthesia techniques and devices：An update[J]. Natl J Maxillofac Surg，2013，4(1):19-24. DOI：10.4103/0975-5950.117873.
[29]
Roeber B, Wallace DP, Rothe V，et al. Evaluation of the effects of the VibraJect attachment on pain in children receiving local anesthesia[J]. Pediatr Dent，2011，33(1):46-50. DOI：10.1177/0194599810389949.
[30]
Chaudhry K, Shishodia M, Singh C，et al. Comparative evaluation of pain perception by vibrating needle（VibrajectTM）and conventional syringe anesthesia during various dental procedures in pediatric patients：a short study[J]. International Dental & Medical Journal of Advanced Research，2015(1):1-5. DOI：10.15713/ins.idmjar.5.
[31]
Goldberg SG. Good vibrations：blocking dental injection pain[J]. Dentistry Today，2014，33(6):30.
[32]
Şermet Elbay Ü, Elbay M, Yıldırım S，et al. Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anesthesia in children：a randomised clinical trial[J]. Int J Pediatr Dent，2016，26(5):336-345. DOI：10.1111/ipd.12204.
[33]
Raslan N, Masri R. A randomized clinical trial to compare pain levels during three types of oral anesthetic injections and the effect of Dentalvible® on injection pain in children[J]. Int J Paediatr Dent，2018，28(1):102-110. DOI：10.1111/ipd.12313.
[34]
Kwak EJ, Pang NS, Cho JH，et al. Computer-controlled local anesthetic delivery for painless anesthesia：a litreature review[J]. Dent Anesth Pain Med，2016，16(2):81-88. DOI：10.17245/jdapm.2016.16.2.81.
[35]
Giannetti L, Forabosco E, Spinas E，et al. Single tooth anesthesia：a new approach to the pediatric patient. A clinical experimental study[J]. Eur J Paediatr Dent，2018，19(1):40-41. DOI：10.23804/ejpd.2018.19.01.07.
[36]
Lanqthasa M, Yeluri R, Jain AA，et al. Comparison of the pain perception in children using comfort control syringe and a conventional injection technique during pediatric dental procedures[J]. J Indian Soc Pedod Prev Dent，2012，30(4):323-328. DOI：10.4103/0970-4388.108931.
[37]
Bansal N, Saha S, Jaiswal J，et al. Pain elimination during injection with newer electronic devices：A comparative evaluation in children[J]. Int J Clin Pediatr Dent，2014，7(2):71-76. DOI：10.5005/jp-journals-10005-1240.
[38]
Sixou JL, Marie-Cousin A, Huet A，et al. Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system（QuickSleeper）[J]. Int J Paediatr Dent，2009，19(5):360-366. DOI：10.1111/j.1365-263X.2009.00983.x.
[39]
Nieuwenhuizen J, Hembrecht EJ, Aartman IH，et al. Comparison of two computerised anaesthesia delivery systems：pain and pain-related behaviour in children during a dental injection[J]. Eur Arch Paediatr Dent，2013，14(1):9-13. DOI：10.1007/s40368-012-0007-2.
[40]
Peedikayil FC, Vijayan A. An update on local anesthesia for pediatric dental patients[J]. Anesth Essay Res，2013，7(1):4-9. DOI：10.4103/0259-1162.113977.
[41]
Sattayut S. Low intensity laser for reducing pain from anesthetic palatal injection[J]. Photomed Laser Surg，2014，32(12):658-662. DOI：10.1089/pho.2014.3770.
[42]
Meesters AA, Bakker MM, de Rie MA，et al. Fractional CO2 laser assisted delivery of topical anesthetics：A randomized controlled pilot study[J]. Laser Surg Med，2016，48(2):208-211. DOI：10.1002/lsm.22376.
[43]
Porritt J, Marshman Z, Rodd HD. Understanding children's dental anxiety and psychological approaches to its reduction[J]. Int J Paediatr Dent，2012，22(6):397-405. DOI：10.1111/j.1365-263X.2011.01208.x.
[44]
Hersh EV, Saraghi M, Moore PA. Intranasal tetracaine and oxymetazoline：a newly approved drug formulation that provides maxillary dental anesthesia without needles[J]. Curr Med Res Opin，2016，32(11):1919-1925. DOI：10.1080/03007995.2016.1238352.
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