Comparative Evaluation of Clinical Anaesthetic Efficacy of 15 % Lidocaine Spray and 20 % Benzocaine Gel during Removal of Arch Bars

Application of arch bar is considered as a gold standard for intermaxillary fixation (IMF) in the management of mandibular fractures. Both the application and removal of arch bars can inflict pain for patients who require IMF. For removal of the arch bars, local anaesthesia (local infiltration or conduction block) is often indicated. The study aimed at comparing and validating the efficacy of topical lidocaine spray and benzocaine gel in patients undergoing removal of arch bars. METHODS30 subjects were included in this prospective randomized controlled trial. Maxillary arch was chosen as the test site. 10 patients (Group A) were anaesthetized in the upper gingiva with 15 % lidocaine spray and remaining 10 patients (Group B) were anaesthetized with 20 % benzocaine gel, following which removal of arch bar was done. 10 patients were included in the control group (Group C) where 2 % lignocaine infiltration was offered only on request. Visual analog scale and Wong-Baker Faces Pain Rating Scale was used to measure the pain perceived by the patient during the procedure. RESULTSThe mean and standard deviation of the pain scores of Group A was 2.5 ± 0.70, Group B was 2.7 ± 0.67 and Control group was 5.5 ± 0.85. Both the test groups had a significant pain reduction when compared with the control group. CONCLUSIONSTopical application of both 15 % lidocaine spray and 20 % benzocaine gel provided equally efficient analgesia and can be useful alternatives to conventional local anaesthetic infiltration during arch bar removal.

Benzocaine, Methemoglobinemia and Methylene Blue / 대한소아치과학회지

The aim of this review is to introduce about the issue of benzocaine and methemoglobinemia. Through blocking the pain during dental treatment, fear and anxiety of patients will be reduced. Thus, anesthetic agent containing benzocaine is commonly used while controlling the pain of patients during treatment. However, on May 28, 2018, the Ministry of Food and Drug Safety reported a medication safety report about restricting the use of benzocaine-containing agents in infants under 24 months and children. Also, they recommended a cautious use to adolescents and adults to prevent methemoglobinemia (MHb). This report was published due to an advice from Food and Drug Administration (FDA) on May 23, 2018. When using agents containing benzocaine, dentists must consider the probability of MHb and prepare for early diagnosis and appropriate action. Since 1930s, methylene blue is known to cure MHb patients. Therefore, the proper use of methylene blue for emergencies and diagnosis methods for early diagnosis of MHb should be familiar to dentists planning for the use of topical anesthetic agents. Dentists should be trained for emergency situation of MHb caused by the use of benzocaine.

Hematological and biochemical characteristics during the transport of dog snapper Lutjanus jocu (Perciformes: Lutjanidae)

The objective of this study was to evaluate stress responses in dog snapper (Lutjanus jocu) during transport by evaluating their hematological and biochemical responses. Twenty-five wild dog snapper specimens were used in the experiment (220 ± 68 g and 24.5 ± 2.5 cm total length). Blood samples were collected prior to transport (control), and fish were placed in two transport boxes, one with anesthetic and one without anesthetic. Immediately after transport and after 24 h, blood was collected from the fish that underwent each treatment (with anesthetic and without anesthetic). Biochemical and hematological results demonstrated the inefficiency of benzocaine as a stress reliever during handling and transport. Biochemical parameters revealed the effects of stress during transport, and after 24 h, glucose levels and hematological parameters (hemoglobin, erythrocytes, leukocytes, neutrophils and MCH) showed a tendency to return to control levels. This study is the first to report stress response measurements of hematological and biochemical indicators in dog snapper, representing an important basis for the planning of future experiments involving the transport and handling of this fish species.(AU)

O objetivo desde estudo foi avaliar as repostas de estresse em dentão (Lutjanus jocu) durante o procedimento de transporte, através de respostas hematológicas e bioquímicas. Vinte e cinco exemplares selvagens de dentão foram utilizados no experimento (220 ± 68 g e 24.5 ± 2.5 cm de comprimento total). Foram realizadas coletas de sangue previamente ao transporte (controle), e os demais peixes foram acondicionados em duas caixas de transporte, uma com anestésico e outra sem anestésico. Imediatamente após o transporte e após 24 h, houve coleta de sangue para cada tratamento (com anestésico e sem anestésico). Os resultados bioquímicos e hematológicos apontam a ineficiência da benzocaína como mitigador do estresse durante o manuseio e transporte. Os parâmetros bioquímicos foram capazes de detectar o efeito do estresse durante o transporte, e após 24 h os níveis de glicose e alguns parâmetros hematológicos (hemoglobina, eritrócitos, leucócitos, neutrófilos e MCH) demonstraram uma tendência de retorno aos níveis do controle. Este trabalho é o primeiro a informar os níveis de resposta basal e de estresse para indicadores hematológicos e bioquímicos em dentão, representando uma base importante para o planejamento de futuras experiências com transporte e manejo dessa espécie.(AU)

Validation of Microbial Limit Test for Compound Benzocaine Gel / 中国药师

Objective: To establish a microbial limit test method for compound benzocaine gel.Methods: According to the general principles of Chinese Pharmacopoeia (2015 edition), method applicable experiments were performed respectively for the routine method, neutralization method and dilution & neutralization method.Using the recovery ratio of test bacteria as the index, the medium of dilution & neutralization method was adopted in the total aerobic microbial count and total combined yeasts and molds count, and the neutralization method was used for the control bacteria detection.The neutralizing agents were polysorbate 80 and lecithin.Results: The method of dilution & neutralization could eliminate the bacteriostasis of the drug, and the recovery ratio of each test bacteria was within the range of 0.5-2.0, which was in line with the requirements of Chinese Pharmacopoeia.Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus could be detected out in the positive control bacterial test,and bacteria were not detected out in the negative test.Conclusion: The method can be used for the microbial limit test for compound benzocaine gel.

Recent advances in topical anesthesia

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.

Efectividad de la benzocaina en gel al 20% y la lidocaina en solución al 10% en pacientes que requieren punción en la mucosa oral: un ensayo clínico controlado aleatorizado cruzado a triple ciego / Effectiveness of benzocaine gel at 20% and lidocaine solution at 10% in patients requiring puncture in the oral mucosa: a randomized controlled crossover triple blind clinical trial

El objetivo del presente estudio fue determinar y comparar la efectividad de la Benzocaína en gel al 20% y la Lidocaína en solución al 10% en pacientes que requerían punción en la mucosa oral. El presente es un ensayo clínico controlado aleatorizado a triple ciego y de diseño cross-over. Se llevó a cabo en la clínica dental de la Unidad de Segunda Especialización en Estomatología (USEE) de la Universidad Nacional de Trujillo, durante los meses de Noviembre y Diciembre del 2010 y de Enero a Marzo del 2011. La muestra estuvo conformada por 60 pacientes, cada paciente firmó un consentimiento informado y se le realizó un análisis de su estado de ansiedad mediante la escala de ansiedad estado-rasgo (IDARE). Antes de realizar la punción en la mucosa oral se aplicó 4 preparados (2 anestésicos tópicos y 2 placebos) para después determinar y comparar la efectividad de los preparados en la reducción del dolor usando la escala visual análoga (EVA). Para la recolección de los datos se usó una ficha especial para tal fin. Para la comparación de la efectividad de los preparados se empleó el Análisis de Varianza (ANOVA). La efectividad de los anestésicos en gel y en solución fue evaluada empleando el test de Tuckey para comparaciones múltiples y el T de students. La significación estadística fue del 5%. Se encontró que la Benzocaína en gel al 20% y la Lidocaína en solución al 10% son efectivos para reducir el dolor a la punción y que no existe una relación estadísticamente significativa (p= 0,0575) entre la efectividad de cada uno de ellos. La administración de Benzocaína en gel al 20% o de la Lidocaína en solución al 10% reduce el dolor a la punción en igual magnitud y pueden ser usados indistintamente en la práctica odontológica diaria.

The objective of this study was to determine the effectiveness of benzocaine 20% gel and lidocaine in 10% solution in patients requiring puncture in the oral mucosa. This is a randomized controlled clinical trial to triple-blind, cross-over design. It was held at the dental clinic of the Unit of Second Specialization in Dentistry (usee) of the National University of Trujillo, in the months of November and December 2010 and January to March 2011. The sample consisted of 60 patients, each patient signed an informed consent and underwent a review of their status by anxiety scale state-trait anxiety (STAI). Before the puncture in the oral mucosa four preparations (2 topical anesthetics and 2 placebo) and then determine and compare the effectiveness of preparations in reducing pain using a visual analogue scale (VAS) was applied. For data collection a special token was used for that purpose. For comparison of the effectiveness of preparations Analysis of Variance (ANOVA). The effectiveness of the gel and anesthetic solution was evaluated using Tukey's test for multiple comparisons and students T. Statistical significance was 5%. We found that benzocaine 20% gel and lidocaine in 10% solution are effective at reducing pain at the puncture and that there is no statistically significant relationship (p= 0.0575) between the effectiveness of each. The administration of benzocaine 20% gel or lidocaine in 10% solution to reduce pain puncture equal and can be used interchangeably in everyday dental practice.

Metahemoglobinemia adquirida en el recién nacido asociada con benzocaína y paracetamol / Association of benzocaine and paracetamol with neonatal-acquired methemoglobinemia

ResumenIntroducción:La metahemoglobinemia adquirida inducida por medicamentos es un trastorno raro en el recién nacido que, de no diagnosticarse y tratarse oportuna y adecuadamente, puede ser particularmente grave y determinar daño cerebral permanente o la muerte del paciente.Caso clínico: Se reporta un caso metahemoglobinemia clínica severa que desarrolló un recién nacido después de la aplicación de una cantidad mínima de crema con benzocaína en una herida quirúrgica anal cuando al mismo tiempo recibía paracetamol. Además de considerar la benzocaína como agente causal primario de la metahemoglobinemia, se analiza y sustenta la posibilidad de que el paracetamol haya aumentado la susceptibilidad del paciente a las caínas debido a la inmadurez enzimática de los sistemas involucrados en la depuración de los agentes oxidantes, en particular de caínas y de paracetamol.Conclusiones: Se alerta sobre la posibilidad de metahemoglobinemia en el recién nacido al emplear caínas solas o junto con otros medicamentos oxidantes en esta época del desarrollo humano, cuando es más susceptible a los efectos oxidantes de químicos incluyendo medicamentos. Se revisa el tratamiento y se propone etiquetar debidamente los productos farmacológicos que contienen caínas, prohibiendo su empleo en recién nacidos para evitar la metahemoglobinemia iatrogénica.

AbstractBackground: Drug-induced acquired methemoglobinemia in the newborn is a rare event; however, when it develops, early diagnosis and proper treatment become paramount because it can evolve rapidly into a particularly serious disease causing permanent brain damage or death.Case report: We report a unique case of severe methemoglobinemia that developed in a newborn associated with a minimal application of a benzocaine healing cream to an anal surgical wound while on acetaminophen. In addition to benzocaine as the primary cause in this case, we raise the possibility that acetaminophen-a mild oxidant-increased the susceptibility of the patient to benzocaine, leading to severe clinical methemoglobinemia based on the known immaturity of the enzymatic systems involved in caines and acetaminophen clearance in the newborn. Treatment of methemoglobinemia is reviewed.Conclusions: Methemoglobinemia is a serious condition that can be easily induced by the use of oxidant medications in the newborn like local anesthetics. The possibility of unexpected drug to drug interactions, particularly between commonly used medications such as acetaminophen with other methemoglobin-causing agents, must always be kept in mind. Because of the possible deleterious consequences, mandatory labelling of caine-containing local anesthetic creams, gels and sprays with a warning for the likelihood of causing severe methemoglobinemia in children is recommended. Also, prohibiting their use in the newborn becomes mandatory.

Preparation and Formulation Optimization of Compound Benzocaine Film / 中国药房

OBJECTIVE:To prepare Compound benzocaine film and optimize the formulation. METHODS:Compound benzo-caine film was prepared with the base materials of polyving akohol-1788 (PVA) and sodium carboxymethyl cellulose (CMC-Na). With the factors of amounts of the base materials PVA and CMC-Na and the additives glycerol and polysorbate 80,and the indexes of the average of the cumulative release rates (0.25 h and 2 h) of the main drugs benzocaine (BZ) and dexamethasone acetate (DA),the orthogonal experiment was conducted to optimize the formulation,and then the optimal formulation was verified. HPLC was adopted to determine the contents of BZ and DA in the preparation for the calculation of cumulative release rates. RESULTS:The optimal formulation was as follows as PVA of 1.2 g,CMC-Na of 1.2 g,glycerol of 1.6 g, polysorbate 80 of 1.5 ml. The con-tents of BZ and DA in the single film prepared respectively were 21.607 mg(RSD=0.71%,n=6)and 4.375 mg(RSD=0.55%, n=6);the average cumulative release rates were respectively 32.7%(RSD=2.01%)and 69.25%(RSD=1.43%)at 0.25 h and 2 h. CONCLUSIONS:The method of preparing the above-mentioned film with homogeneous contents is simple.

Double-Blind Study of Intrarectal Administration of Anesthetic Agent for Pain Control during Transrectal Prostatic Biopsy / 대한남성과학회지

PURPOSE: We evaluated the safety and efficacy of intrarectal administration of anesthetic agent for transrectal prostate biopsy. MATERIALS AND METHODS: For a double-blind prospective trial, 100 men undergoing transrectal prostate biopsy were randomized into three groups using an established list. In the control group (n=36), 40mL of normal saline was administered transrectally 10 min before the procedure. The lidocaine group (n=31) and the benzocaine group (n=33) were give 40 mL of 1% lidocaine and 0.3% benzocaine, respectively. Patients were asked to score the severity of the pain expected before and after the biopsy procedure using a self-administered verbal rating scale. Pain was assessed using a 10-point linear visual analog scale. RESULTS: The median pain score expected before the transrectal prostate biopsy was 6.7+/-0.3, 7.1+/-0.2, and 6.7+/-0.3 in the control, lidocaine, and benzocaine group, respectively. The median pain score during the biopsy was 6.1+/-0.3, 5.8+/-0.3 (P<0.05), and 5.9+/-0.4 in the control, lidocaine, and benzocaine group, respectively. Ninety seven percent of the control group, 100% of the lidocaine group, and 91% of the benzocaine group complained of severe and bothersome pain, with a score of 5 or greater during the biopsy. No adverse events were noted. CONCLUSIONS: Intrarectal administration of anesthetic agent is a simple, safe, and efficacious method of providing satisfactory anesthesia in patients undergoing transrectal prostate biopsy. We recommend 1% lidocaine solution in the patients to perform transrectal prostatic biopsy.