Analgesic Effects of Extraoral Ultrasound Block of Mandibular Nerve for the Extraction of Lower Third Molars

Study Overview
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Brief Summary
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This is a study about the dynamics and effects of different types of blocks (intraoral conduction anesthesia of the alveolar nerve and extraoral US block of the mandibular nerve) for extraction of lower third molars.

Detailed Description
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Standard method of anesthesia for extraction of horizontally positioned lower thirdmolars is intraoral conduction anesthesia of the inferior alveolar nerve. However, the analgesiceffect of block is short and it is necessary to use analgesics. In this prospective clinical study,analgesic effect of ultrasound (US) -guided extraoral block of mandibular nerve will beinvestigated, in order to prolong pain-free time and reduce the use of analgesics associated withrisks (bleeding, hepatotoxicity). Characteristics of alveolar nerve block and US block of the mandibular nerve will becompared, such as: pain during application of anesthesia, amount of anesthetic, duration ofanesthesia, need to use analgesics, time to and level of pain when using analgesics, andcomplications

Official Title
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Analgesic Effects of Extraoral Ultrasound Block of Mandibular Nerve for the Extraction of Lower Third Molars

Conditions
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Molar, Impacted Teeth

Intervention / Treatment
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* Procedure: US guided block of mandibular nerve
* Procedure: Intraoral block of lower alveolar nerve


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18-64 years horizontally placed lower third molars ASA I or II group Exclusion Criteria: allergy to local anesthetics local infection at the site of needle puncture parotitis serious liver disease use of antiarrhythmics group III (eg amiodarone), anticoagulant or antithrombotic drugs lactation people who took an analgesic as a preventive measure before coming to the procedure

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: US block of mandibular nerve<br>Extraoral ultrasound-guided block of the mandibular nerve will be performed iusing an ultrasound device. After visualisation of the pterygomandibular space, of the maxillary artery and the mandibular nerve next to it, at a depth of 2-4 cm, the detection of the maxillary artery is confirmed by Color Doppler. A needle enters between the coronoid and condylar processes, using the out of plane technique, near the maxillary artery, and after negative aspiration, local anesthetic ropivacaine (0.75%, 2.5 mL) will be applied. | Procedure: US guided block of mandibular nerve<br>* Extraoral ultrasound-guided block of the mandibular nerve will be performed in the examined group using an ultrasound device, using ropivacaine (0.75%, 2.5 mL).<br>|
| Active Comparator: intraoral block of lower alveolar nerve<br>During the intraoral block of the inferior alveolar nerve, the patient will lie with his mouth wide open, and the inferior alveolar, lingual and buccal nerves will be anesthetized using two injections. The anesthetic used will be 40 mg/mL articaine chloride+0.01 mg/mL epinephrine: the planned amount of anesthetic is 2×1.7 mL, and if anesthesia is not achieved, an additional volume of anesthetic will be added as needed, until anesthesia | Procedure: Intraoral block of lower alveolar nerve<br>* Block of lower alveolar nerve will be applied intraoraly using articaine+adrenaline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time without pain |  | first 24 postoperative hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of numbness |  | first 24 postoperative hours | 
| Pain level when anesthesia is applied | 0-10 on VAS | first 24 postoperative hours | 
| Pain level when painkiller is needed | 0-10 on VAS | first 24 postoperative hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dental anesthesia, inferior alveolar nerve, regional anesthesia, ultrasound, mandibular nerve