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Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study
Rupak Kumar Dasarraju1, Nirmala Svsg2
1Department of Pedodontics and Preventive Dentistry, Priyadarshini Dental College & Hospital, Pandur, Thirivallur, Tamilnadu, India.
Insights
Cetacaine demonstrated superior effectiveness in reducing injection pain for children aged 7-11 compared to benzocaine and EMLA. This study highlights Cetacaine as a preferred topical anesthetic for pediatric dental procedures.
Area of Science:
- Pediatric Dentistry
- Pain Management
- Anesthesiology
Background:
- Dental anxiety and pain are significant concerns in pediatric patients during local anesthetic injections.
- Effective topical anesthetics are crucial for improving the patient experience and cooperation during dental procedures.
- This study addresses the need for evidence-based recommendations on topical anesthetic efficacy in children.
Purpose of the Study:
- To compare the efficacy of three intraoral topical anesthetics in mitigating needle prick pain from local anesthetics in children.
- To evaluate benzocaine 20% jelly, cetacaine anesthetic liquid, and EMLA cream for pain reduction.
- To provide data to guide the selection of topical anesthetics in pediatric dentistry.
Main Methods:
- A prospective, single-blind, randomized clinical trial involving 90 children aged 7-11 years.
- Participants were randomized into three groups receiving benzocaine, cetacaine, or EMLA for 1 minute before injection.
- Pain was assessed using self-reported (Faces Pain Scale-Revised), behavioral (FLACC, CPS), and physiological (pulse rate) measures.
Main Results:
- Cetacaine significantly reduced self-reported, behavioral, and physiological pain scores compared to benzocaine and EMLA (P < 0.001).
- No significant difference in pain reduction was observed between the benzocaine and EMLA groups.
- Cetacaine emerged as the most effective agent in this pediatric cohort.
Conclusions:
- Cetacaine is a highly effective topical anesthetic for reducing injection pain in children.
- It offers a significant advantage over benzocaine 20% jelly and EMLA cream for palatal injection pain.
- Clinical practice can benefit from incorporating Cetacaine for improved pediatric dental anesthesia.
Background:
This study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7-11 years old.
Methods:
It is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7-11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) - Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R - Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant.
Results:
The Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick.
Conclusion:
Cetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.
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