Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler...

Area of Science:

• Dentistry
• Anesthesiology
• Pharmacology

Background:

• Achieving effective local anesthesia without injections is a significant goal in dentistry.
• Pulpal blood flow (PBF) is a critical factor in assessing anesthetic efficacy.
• Minimally invasive anesthetic delivery methods are highly desirable.

Purpose of the Study:

• To compare the effects of a novel nasal spray anesthetic (3% tetracaine plus 0.05% oxymetazoline nasal spray; KNS) with traditional injections (2% lidocaine with 1:100,000 epinephrine; LE, and 3% mepivacaine plain; MP) on PBF, anesthetic efficacy, and patient preference.
• To evaluate the clinical performance of KNS as a potential alternative to injectable local anesthetics.

Main Methods:

• A double-blind, cross-over study involving 20 subjects.
• Participants received KNS, LE, or MP (or their respective placebos) in separate visits.
• Pulpal blood flow was measured using laser Doppler flowmetry, and anesthetic success was determined by electric pulp testing.

Main Results:

• Lidocaine with epinephrine injections significantly reduced PBF, while KNS and mepivacaine plain did not.
• Anesthesia success rates were highest for LE (85%), followed by MP (35%), and lowest for KNS (5%).
• Kovanaze resulted in significantly higher postoperative pain and was the least preferred anesthetic, with more adverse events reported.

Conclusions:

• The nasal spray formulation of tetracaine and oxymetazoline (Kovanaze) was not effective for achieving pulpal anesthesia in this study.
• Injectable lidocaine with epinephrine demonstrated superior anesthetic efficacy and reduced pulpal blood flow compared to Kovanaze and mepivacaine plain.