This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
A Comparative Study of Hyfrecator Ablation to that of Cryosurgery in the Mana...inventionjournals
: 605 patients in a Tertiary care center during a period of one year with benign skin growths were treated with either Electro surgery or Cryo surgery. 314 were treated with Hyfrecator and 291 were treated with Cryo surgery. Both procedures were done as op procedures without much complications and they were very much cost effective. There were no recurrences in both groups with a follow up period of 30 days. Hyfrecator scores slightly better compared to Cryo-surgery in this study with regards to scar formation and costwise.
A Comparative Study of Hyfrecator Ablation to that of Cryosurgery in the Mana...inventionjournals
: 605 patients in a Tertiary care center during a period of one year with benign skin growths were treated with either Electro surgery or Cryo surgery. 314 were treated with Hyfrecator and 291 were treated with Cryo surgery. Both procedures were done as op procedures without much complications and they were very much cost effective. There were no recurrences in both groups with a follow up period of 30 days. Hyfrecator scores slightly better compared to Cryo-surgery in this study with regards to scar formation and costwise.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
Non Surgical Periodontal Therapy by Dr Santosh Martandesantoshmds
Review and Essay Material on Non Surgical Periodontal Therapy. Illustrative Contents for proper presentation on all aspects of NSPT. The Presentation helps in drafting A to Z of NSPT. Readers are encouraged to add newer studies and ideas under each aspect of NSPT.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
Non Surgical Periodontal Therapy by Dr Santosh Martandesantoshmds
Review and Essay Material on Non Surgical Periodontal Therapy. Illustrative Contents for proper presentation on all aspects of NSPT. The Presentation helps in drafting A to Z of NSPT. Readers are encouraged to add newer studies and ideas under each aspect of NSPT.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Postoperative recovery after mandibular third molar surgery. By Dr. Akhila Damodar { dr.akhila.n@gmail.com }
This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures.
Krishna BP, Reddy BP, Yashavanth Kumar DS, Ummar M, Shekhar V, Chandra Tiwari RV. Role of Serratiopeptidase and Dexamethasone in the Control of Postoperative Swelling. Ann Maxillofac Surg. 2020 Jan-Jun;10(1):108-113. doi: 10.4103/ams.ams_249_19. Epub 2020 Jun 8. PubMed PMID: 32855925; PubMed Central PMCID: PMC7433958.
44.Rohini Kanitkar Kamat et al. A Comparative Assessment of the Efficiency of ThreeDimensional plates over single Superior Border Plating in the management of Mandibular Angle Fractures. J Res Adv Dent 2020;10:3s:17-22.
42.Shilpa Sunil Khanna et al. Efficacy of Tranexamic Acid on Intraoperative Blood Loss in third molar Surgery: A Split Mouth Randomized Study. J Res Adv Dent 2020;10:3:192-196.
Effect of Surgery Difficulty According to Impaction Level on the Incidence of...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
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Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 905 Volume 9 : Issue 2 : February 2020
substances which act as mediators of the inflammatory response.
These symptoms are not observed immediately after surgery
but rather begin gradually, peaking 2 days after the procedure.
Apart from nonsteroidal antiinflammatory drugs, corticosteroids
have been widely used in a number of clinical trials as an aid to
improve the post‑surgical sequelae.[2]
Steroids prevent diapedesis,
the initial leakage of fluids from the capillaries, and stabilize the
membranes of the cellular lysosomes which hold large quantities
of hydrolytic enzymes. There is also a decrease in the formation
of bradykinin, a powerful vasodilating substance, thereby
reducing the postoperative swelling.[3]
However even with ample
clinical trials, clinicians remain uncertain about the preferred
route of administration of steroids.[4]
This study compares
the effectiveness of pterygomandibular nerve block using 2%
lignocaine HCL with 1:80,000 adrenaline to twin mix (4 mg of
dexamethasone mixed with 2% lignocaine Hcl with 1:80,000
adrenaline) on postoperative discomfort after mandibular third
molar surgery.
Materials and Methods
Patient selection and anesthesia
This study was conducted with kind approval from the
institutional ethical committee (20-12-2017) with proper
signed informed consent being taken from the patients before
the procedure.[5]
The study containing 40 subjects, referred
to the department of oral and maxillofacial surgery, were
divided into 20 subjects each in group A (control group) and
group B (twin‑mix group). Patients within the age range of
18–60 years planned for elective surgical removal of unilateral
impacted mandibular third molar and fulfilling the inclusion
criteria were selected for the study. All patients were of Indian
origin. The inclusion criterion was ASA Class I subjects
presenting with unilaterally impacted mandibular third molar
with similar difficulty indices. The exclusion criteria were
the presence of acute infection and/or swelling and pain at
the time of surgery, medically compromised patients, any
history of allergy to local anesthetic drugs, and refusal of
informed consent. Each patient was randomly selected to
receive anesthesia using 1.8 ml 2% lignocaine with 1:80,000
epinephrine in group A or 2.8 ml twin mix (1.8 ml 2% lignocaine
with 1:80,000 epinephrine + 1 ml 4 mg dexamethasone) in
group B. Preparation of twin mix was done by mixing 1.8 ml
of 2% lignocaine with 1:80,000 epinephrine with 1 ml of 4 mg
dexamethasone immediately before dispensing.[6]
The same
operator performed all inferior alveolar nerve block injections
in a standardized manner. Two plane aspiration was done and
the solution was deposited at the rate of 1 ml/min. After
injecting the anesthetic solution, the time to anesthetic effect
was recorded (defined as the time elapsed from full needle
withdrawal until the onset of subjective signs of anesthesia),
also the duration of anesthesia was recorded from initial patient
perception of the anesthetic effect to the time when the effect
subsides. The need to reanesthetize the surgical site was also
recorded. A 10‑point visual analog scale (VAS) was used to
subjectively assess the overall pain intensity while injecting the
study drug, during surgery, and in the postoperative period. All
the findings were carefully recorded and statistically analyzed.
Surgical procedure
All the patients received antibiotics (amoxicillin + clavulanic acid
625 mg) 1 h prior to surgery. Surgical access to the mandibular
third molars was achieved using wards or modified ward’s incision
depending upon the difficulty level of impaction, mucoperiosteal
flap was raised, and bone removal was done with a 702 surgical
carbide tapered fissure bur (SS White) using straight surgical
micro‑motor/hand piece under copious normal saline irrigation.
The impacted tooth was removed in toto or after odontectomy
as desired, based on the type of impaction and root pattern.
Surgical site was thoroughly irrigated and sutured with 3–0
silk sutures. The time required for each surgical procedure was
recorded from incision to the placement of the last suture.
Postoperative instructions were given to the patients. All the
patients were prescribed tablets amoxicillin + clavulanic acid
625 mg and diclofenac potassium 50 mg tablet twice for 5 days.
Each patient was evaluated for postoperative pain, facial swelling,
and maximal mouth opening on the first, third, and seventh
postoperative day. Pain was recorded using 10‑point VAS scale;
facial swelling using measurements between tragus to angle
of mouth, menton, and angle of mandible, and postoperative
maximal mouth opening interincisally using vernier caliper.[7]
Results
All the 20 nerve blocks in group B (twin‑mix group)
were successful, not requiring reanesthesia, whereas, in
group A (control group), 05 out of 20 subjects required
the need for reanesthesia. The mean time recorded for the
surgical procedure was 26.9 ± 4.12 min for study group A
and 29.8 ± 4.18 min for study group B, showing no statistical
difference (t = 0–2.206, P = 0–0.73). Mean VAS value for the
pain/sting on local anesthetic injection/block was 1.05 ± 0.68 for
study group B which was comparatively less than study group A,
i.e. 1.70 ± 1.08 [Table 1]. Time of onset of local anesthesia was
51.35 ± 7.15 s for study group B which was significantly less as
compared to 80.85 ± 10.00 s for study group A, showing the much
faster onset of anesthesia in case of twin‑mix group. The mean
duration of soft tissue anesthesia was clinically and statistically
much longer for study group B (250.85 ± 37.86 min) than study
group A (142.10 ± 36.84 min) Table 2. Intraoperative VAS
scores did not show any statistical difference between the study
group B (0.75 ± 0.85) and the control group A (1.75 ± 0.91).
Postoperative mean visual analog scale scores for group B were
Table 1: Mean VAS value for the pain/sting on local
anesthetic injection/block
Solution Mean (±SD) VAS value for the pain/
sting on local anesthetic injection/block
2% Lignocaine with
1:200,000 Epinephrine
1.7000±1.08
Twin mix 1.0500±0.68
[Downloaded free from http://www.jfmpc.com on Tuesday, March 3, 2020, IP: 183.83.106.191]
3. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 906 Volume 9 : Issue 2 : February 2020
lower in the first, third, and seventh postoperative day [Table 3].
On the first postoperative day, in the control group A, there was
a gradual increase in the facial swelling from the first to third
postoperative day followed by the reduction in the swelling till
seventh postoperative day. In the study group B, facial swelling
was maximum on the first postoperative day followed by a
reduction in the swelling till seventh postoperative day. Mean
reduction in mouth opening in group B was significantly lower
on the first, third, and seventh postoperative day. On comparative
evaluation between study group A and study group B, patients
in the control group had more severe swelling and reduction in
mouth opening in the postoperative period. Recovery from the
local anesthetic was complete, without any residual deficit in all
the patients in both the study groups.
Discussion
Every oral surgeon encounters problems of pain, swelling,
and trismus associated with third molar surgery.[3]
Steroids
are added to local anesthetic agents in order to prolong the
duration of anesthesia and improve the quality of pain relief.
This combination provides both neuroaxial route and peripheral
nerve blocks.[8‑10]
Dexamethasone exerts potent antiinflammatory
action by inducing the synthesis of endogenous proteins, which
acts by blocking the enzymatic activation of phospholipase
A2.[11]
Dionne et al. stated that glucocorticoids act as potential
suppressor agents of multiple signaling pathways involved in the
inflammatory response causing decreased levels of inflammatory
mediators at the site of injury, and therefore, corticosteroids
are used as the drug of choice used after surgical procedures to
suppress acute inflammatory manifestations.[12]
Bhargava et al. in their prospective study used dexamethasone as
an intraspace injection in surgical removal of mandibular third
molars and found that addition of dexamethasone to lignocaine
and its administration as an intraspace injection significantly
shortens the latency and prolongs the duration of the soft
tissue anesthesia, thereby improving the quality of life in the
postoperative period.[11]
In our study, 1 ml (4 mg) dexamethasone with 2% lignocaine
is used as an intraspace injection prior to third molar surgery.
All the patients in group T showed a mean latency of
51.3500 ± 7.15 s and longer duration of soft tissue anesthesia
(mean 250.8500 ± 37.86 s).
Grossi et al.[13]
concluded that corticosteroids are primarily
used after surgical procedures for suppressing tissue mediators
of inflammation, thereby reducing transudation of fluids and
lessening edema. Although some reduction of postoperative pain
generally accompanies a reduction of edema, steroids alone do
not have a clinically significant analgesic effect.
In our study, patients in study group T showed a significant
reduction in VAS score on the first, third, and seventh
postoperative day.
In a well‑conducted trial with patients serving as their own
control, Graziani et al.[14]
investigated the effect of submucosal
injection of dexamethasone 4 mg in 43 subjects undergoing
bilateral surgical extraction of lower third molars. With regard to
the edema analysis, each treatment subgroup showed a reduced
postoperative degree of edema compared with the control
group, as highly significant on the second postoperative day as
after 1 week.
In agreement with Graziani et al.,[14]
our data shows that the
intraspace administration of dexamethasone 4 mg resulted in a
highly significant decrease in edema on the third postoperative
day.
Bhargava et al.[15]
in their study concluded that twin‑mix
administration did reduce the severity of trismus in the study
patients when seen in comparison to the control group. The
reduction of trismus may be attributed to the suppression of fluid
transudation and relatively lesser edema in the twin‑mix group.
In our study, patients in study group T showed a significant
reduction in postoperative trismus in the first, third, and seventh
day.
Berrada et al. reported in their study that alkalinization of local
anesthetic agents may shorten the onset time and lengthen the
duration of action and, hence, increases its clinical effectiveness,
and makes its injection more comfortable.[16]
Local anesthetics
exist in equilibrium between the basic uncharged (nonionized)
form, which is lipid‑soluble, and the charged (ionized) cationic
form, which is water‑soluble. Lipid soluble, nonionized form
of the local anesthetic penetrates the neural sheath and nerve
membrane. The ionized form of the local anesthetic binds with
the sodium channel and prevents the propagating of nerve
Table 2: Mean latency and duration of the soft tissue
anesthesia in the study groups
Study group Mean latency in sec (±SD) Mean duration in min (±SD)
Group C 80.8500±10.00 142.1000±36.84
Group T 51.3500±7.15 250.8500±37.86
‘t’ ‑10.728 9.206
Table 3: Mean operative and postoperative visual analog scale scores
Study
group
Mean visual analog scale scores (± SD)
Surgical Procedure First postoperative day Third postoperative day Seventh postoperative day
Group C 1.7500±0.91047 2.7500±1.16416 2.1000±1.02084 0.9000±0.91191
Group T 0.7500±0.85070 1.2000±0.76777 0.6000±0.68056 0.2000±0.41039
[Downloaded free from http://www.jfmpc.com on Tuesday, March 3, 2020, IP: 183.83.106.191]
4. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 907 Volume 9 : Issue 2 : February 2020
impulses. Altering the pH to a more basic solution tends to
increase the amount of nonionized form compared to ionized
form which will speed the onset of action. Increasing the pH
of lidocaine decreases the pain associated with its infiltration.[17]
This study utilized 2.8 ml study solutions for pterygomandibular
nerve blocks to maintain volume parameter consistent in
twin‑mix groups, 1 ml more than the standard inferior alveolar
block. Steroid induces shorter onset and prolonged duration,
apart from change in pH, which may also be due to the property
of vasoconstriction of dexamethasone, or by an increase in the
activity of the inhibitory potassium channels on nociceptive
C‑fibers (via glucocorticoid receptors), thus decreasing their
activity.[18,19]
Addition of dexamethasone increases the pH,
thereby increases the amount of free base of the local anesthetic,
decreases the time required for onset of the anesthetic, decreases
pain during injection, and improves overall patients postoperative
comfort and quality of life as demonstrated by the postoperative
VAS scores and measurements for the facial swelling and
reduction in mouth opening.
In this study, patients in group T showed a significantly faster
onset of anesthesia (mean: 51.35 ± 7.15 s). Pain during injection
for both groups C and T does not show much statistical
difference, whereas VAS score for group T shows a significant
decrease in pain on postoperative first, third, and seventh day.
Facial swelling for patients of group T shows a significant
decrease in the postoperative first, third, and seventh day with
the peak level on the third postoperative day. Patients of group T
does not show much decrease in mouth opening as compared
to group C.
Conclusion
Clinical anesthetic efficacy of twin mix offers the advantage
of single prick co‑administration of dexamethasone with
local anesthetic, lesser sting of local anesthetic injection,
shorter aesthetic latency, and prolonged duration of the
soft tissue anesthesia and a decrease in postoperative
discomfort after the oral surgical procedure. A long‑term
stability study is mandated to assess the compatibility of
the mixture components for its production, storage, and
shelf‑life assessment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient
consent forms. In the form, the patients have given their consent
for their images and other clinical information to be reported in
the journal. The patients understand that their names and initials
will not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Grossi GB, Maiorana C, Garramone AR, Borgonovo A,
Creminelli L, Santoro F, et al. Assessing postoperative
discomfort after third molar surgery: A prospective study.
J Oral MaxillofacSurg 2007;65:901‑17.
2. Markiewicz MR, Brady MF, Ding EL, Dodson TB.
Corticosteroids reduce postoperative morbidity after
third molar surgery: A systematic review and meta‑analysis.
J Oral MaxillofacSurg 2008;66:1881‑94.
3. Dhanavelu PR, Gapriyan S, Ebenezer V, Balakrishnan EM.
Dexamethasone for third molar surgery—A review. Int J
Pharma Bio Sci 2013;4:9‑13.
4. Ruta DA, Bissias E, Ogston S, Ogden GR. Assessing
health outcomes after extraction of third molars: The
postoperative symptom severity (PoSSe) scale. Br J Oral
Maxillofac Surg 2000;38:480‑7.
5. Bhargava D, Deshpande A. Twin‑mix anesthesia as
pterygomandibular nerve block for surgical removal of
impacted mandibular third molars. J Stomat Occ Med.
2015;8:29‑32.
6. Bhargava D, Sreekumar K, Rastogi S, Deshpande A,
Chakravorty N. A prospective randomized double‑blind
study to assess the latency and efficacy of Twin‑mix and 2%
lignocaine with 1: 200,000 epinephrine in surgical removal
of impacted mandibular third molars: A pilot study. Oral
Maxillofac Surg 2013;17:275‑80.
7. Sreekumar K, Bhargava D. A prospective randomized
double‑blind study to assess the latency and efficacy of
articaine and lignocaine in surgical removal of impacted
mandibular third molars in Indian patients. J StomatOcc
Med 2012;5:10‑4.
8. Shrestha BR, Maharjan SK, Tabedar S. Supraclavicular
brachial plexus block with and without dexamethasone—A
comparative study. Kathmandu Univ Med J 2003;1:158‑60.
9. Banaszkiewicz PA, Kader D, Wardlaw D. The role of caudal
epidural injections in the management of low back pain.
Bull Hosp Jt Dis 2003;61:127‑31.
10. Bansal S, Turtle MJ. Inadvertent subdural spread
complicating cervical epidural steroid injection with local
anaesthetic agent. Anaesth Intensive Care 2003;31:570‑2.
11. Bhargava D, Sreekumar K, Deshpande A. Effects of intra‑space
injection of twin mix versus intraoral‑submucosal,
intramuscular, intravenous and per‑oral administration of
dexamethasone on post‑operative sequelae after mandibular
impacted third molar surgery: A preliminary clinical
comparative study. Oral Maxillofac Surg 2014;18:293‑6.
12. Dionne RA, Gordon SM, Rowan J, Kent A, Brahim JS.
Dexamethasone suppresses peripheral prostanoid levels
without analgesia in a clinical model of acute inflammation.
J Oral Maxillofac Surg 2003;61:997‑1003.
13. Grossi GB, Maiorana C, Garramone RA, Borgonovo A,
Beretta M, Farronato D, et al. Effect of submucosal injection
of dexamethasone on postoperative discomfort after third
molar surgery: A prospective study. J Oral Maxillofac Surg
2007;65:2218‑26.
14. Graziani F, D’Aiuto F, Arduino PG, Tonelli M, Gabriele M.
Perioperative dexamethasonereduces post‑surgical sequelae
of wisdom tooth removal. A split‑mouth randomized
[Downloaded free from http://www.jfmpc.com on Tuesday, March 3, 2020, IP: 183.83.106.191]
5. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 908 Volume 9 : Issue 2 : February 2020
double‑masked clinical trial. Int J Oral Maxillofac Surg
2006;35:241‑6.
15. Bhargava D, Deshpande A, Khare P, Pandey SP, Thakur N.
Validation of data on the use of twin mix in minor oral
surgery: Comparative evaluation of efficacy of twin mix versus
2% lignocaine with 1: 200000 epinephrine based on power
analysis and an UV spectrometry study for chemical stability
of the mixture. Oral Maxillofac Surgery 2015;19:37‑41.
16. Berrada R, Chassard D, Bryssine S, Berthier S, Bryssine B,
Boulétreau P. In vitro effects of the alkalinization of
0.25% bupivacaine and 2% lidocaine. Anne Fr Anesth
Reanim 1994;13:165‑8
17. Malamend SF. Buffering local anesthetics in dentistry. Pulse
2011;4:8‑9.
18. Cummings KC 3rd
, Napierkowski DE, Parra‑Sanchez I, Kurz A,
Dalton JE, Brems JJ, et al. Effect of dexamethasone on the
duration of interscalene nerve blocks with ropivacaine or
bupivacaine. Br J Anaesth 2011;107:446‑53.
19. Tandoc MN, Fan L, Kolesnikov S, Kruglov A, Nader ND.
Adjuvant dexamethasone with bupivacaine prolongs the
duration of interscalene block: A prospective randomized
trial. J Anesth 2011;25:704‑9.
[Downloaded free from http://www.jfmpc.com on Tuesday, March 3, 2020, IP: 183.83.106.191]