The classical procedure of block mandibular anesthesia, defined more correctly as a inferior alveolar nerve block, represents an anesthetic method subject to considerable failure rates, attested in up to 20-25%, and which can reach even higher levels under certain conditions, with the first condition being acute irreversible pulpitis. In this regard, some methods have been described to increase the level of effectiveness of the action of the local anesthetic through pharmacological intervention. In this sense, changes in the dosage of the drug and vasoconstrictor (intrinsic interventions could be said), extrinsic interventions such as the buffering of the pH of the anaesthetic solution, or active modification of the pharmacological treatment, through the replacement of the anaesthetic molecule or the exploitation of the effects of other administered molecules can be distracted. An exemplary case is a premedication with non-steroidal anti-inflammatory drugs (NSAIDs), the subject of a specific discussion previously published on these pages.
In opposition to NSAIDs, it seems interesting to consider the role of corticosteroid molecules.
These drugs are currently used in surgery, being able, for example, to reduce postoperative morbidity after the extraction of the third molar, limiting the formation of edema and the risk of trismus. The most common route of administration is intramuscular.
In minor oral and maxillofacial surgery procedures, the possibility of administering the steroid molecule in conjunction with the local anesthetic during the inferior alveolar block procedure, whose target site is the pterygomandibular space, is also described. This method was recently studied by the Bhargava group, which published a preliminary report of the outcome in December 2018 in Oral and Maxillofacial Surgery.
The study was prepared according to a randomized double-blind clinical trial model to evaluate the plasma concentration and clinical outcome of administering a 2% lidocaine preparation with adrenaline 1:200000 (1.8 mL, corresponding to a cartridge) and dexamethasone (4 mg per 1 mL), in the context of a normal inferior alveolar block procedure, in a total of 30 patients referred by extraction of the third molar included. The sample was divided into a study group called “IS” and a double check: one group with a simple lower alveolar block and one with intramuscular corticosteroid addition.
From a pharmacological viewpoint, this option is considered safe, as the results show a plasma concentration that is not significantly different from that of intramuscular administration. The clinical findings of reduction of swelling and trismus compared to the control are also comparable and lead to define, as a preliminary, as predictable the technique, the use of which seems particularly suitable in the case of surgeries investigated, as may be bilateral extractions of the lower third molar included.