Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen
Princy S Thomas1, Bhavna H Dave2, Devanshi J Shah3
1Private Practitioner, Jubail, Saudi Arabia.
Insights
Nitrous oxide-oxygen (N2O-O2) inhalation significantly reduced anxiety in children during dental procedures compared to oxygen alone. This method offers a comfortable, non-pharmacological approach to managing behavior during invasive treatments.
Area of Science:
- Pediatric Dentistry
- Anesthesiology
- Behavioral Science
Background:
- Managing anxiety in children during dental procedures, especially invasive ones like inferior alveolar nerve blocks (IANB), is crucial for successful treatment.
- Non-pharmacological behavior management adjuncts are sought to improve patient comfort and cooperation.
Purpose of the Study:
- To comparatively evaluate children's anxiety levels during inferior alveolar nerve block (IANB) administration using nitrous oxide-oxygen (N2O-O2) inhalation sedation versus oxygen (O2) inhalation.
- To assess the anxiolytic and sedative effects of N2O-O2 inhalation in pediatric dental patients.
Main Methods:
- A randomized clinical study involving 60 children aged 3-12 years with Frankl behavior ratings of 2-3 requiring IANB.
- Group I (n=30) received 25-50% N2O-O2 inhalation sedation; Group II (n=30) received 100% O2 as placebo.
- Anxiety and discomfort were measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale; sedation levels were assessed using the Ramsay Sedation Score (RSS); physiological parameters were monitored.
Main Results:
- Significant differences in FLACC scores were observed between groups intraoperatively (p=0.002) and postoperatively (p=0.049), favoring the N2O-O2 group.
- The mean Ramsay Sedation Score was higher in the N2O-O2 group (2.80 ± 1.03) compared to the O2 group (1.80 ± 0.81).
- All recorded physiological parameters remained within normal ranges for both groups.
Conclusions:
- Nitrous oxide-oxygen (N2O-O2) inhalation significantly improves anxiety levels in children undergoing IANB.
- N2O-O2 inhalation demonstrates effective anxiolytic and sedative properties compared to oxygen inhalation alone.
- N2O-O2 inhalation serves as a valuable non-pharmacological adjunct for behavior management during invasive pediatric dental treatments, enhancing child comfort.
Aim:
A comparative evaluation of children's anxiety with the use of nitrous oxide-oxygen (N2O-O2) inhalation sedation during the administration of inferior alveolar nerve block (IANB).
Materials And Methodology:
A total of 60 children between 3 and 12 years of age, with Frankl's behavior rating of 2-3 requiring IANB for any dental procedure were enrolled in this randomized clinical study. Group I (n = 30) received N2O and oxygen inhalation sedation at a concentration in the range of 25-50%, whereas group II (n = 30) received 100% O2 as a placebo. The physiological parameters like pulse rate, respiration, blood pressure, and O2 saturation were measured at the baseline, intraoperatively [during and after administration of local anesthesia (LA)] and postoperatively after the termination of the gases in both groups. The sedation level was measured intraoperatively (before administration of LA) using the Ramsay Sedation Score (RSS). The discomfort and anxiety were measured at the baseline, intraoperatively, and postoperatively using the Face, Legs, Activity, Cry, Consolability (FLACC) behavior scale. The data were evaluated using the statistical software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistics 20.0.
Results:
There was a significant difference in the FLACC scores between the two groups, intraoperatively (p-value-0.002), and postoperatively (p-value-0.049). The mean of the RSS for group I was 2.80 + 1.03, and for group II was 1.80 + 0.81. All the physiological parameters recorded were within the normal range.
Conclusion:
The use of N2O-O2 inhalation improved the anxiety levels in children while receiving the IANB and showed significant anxiolytic and sedative effects as compared to O2 inhalation.
Clinical Significance:
Nitrous oxide-oxygen (N2O-O2) inhalation can be used as a nonpharmacological behavior management adjunct for invasive treatments for children with utmost comfort for the child.
How To Cite This Article:
Thomas PS, Dave BH, Shah DJ, et al. Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(1):30-36.
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