Efficacy of ethyl chloride topical anesthesia application on pain perception during intra-oral injections in children compared to benzocaine gel—a single-blind randomized controlled trial
Aug 2026· Frontiers in Dental Medicine· Vol 7· 0 citations· 34 references
Medicine
TL;DR
Both anesthetic agents produced comparable physiological responses, self-reported experiences, and behavioral reactions during intra-oral local anesthetic injections in cooperative children aged 7–10 years, and the superiority trial did not reveal a statistically significant difference.
Abstract
Background Pain management during local anesthesia administration is a critical factor in pediatric dentistry. This assessor-blind, parallel-group, superiority randomized controlled trial (ClinicalTrials.gov: NCT06011005) aimed to determine whether ethyl chloride (EC) spray applied via a cotton pellet provides superior pain reduction compared to 20% benzocaine (BC) gel during intra-oral local anesthetic injections in children. Methods Fifty-seven healthy children aged 7–10 years requiring routine dental local anesthesia were randomized to Group A (20% BC gel, n = 29) or Group B (EC spray via cotton pellet, n = 28). The primary outcome was physiological stress measured by change in heart rate (HR). Secondary outcomes included self-reported pain (Faces Pain Scale, FPS) and observed behavioral response (Sound-Eye-Motor scale, SEM). The outcomes assessor was blinded to the topical agent used. Between-group differences in change scores were analyzed using the Mann–Whitney U test with Hodges–Lehmann median differences and bootstrap 95% confidence intervals. Results Both groups demonstrated slight increases in HR following the injection; however, the magnitude of change was not significantly different between the groups (BC: +4.03 bpm vs. EC: +2.14 bpm; Mann–Whitney U p = 0.310; 95% CI of mean difference: −1.53 to 5.35). Additionally, there were no statistically significant differences between the groups regarding self-reported pain levels (FPS change: BC +1.31 vs. EC +1.25; p = 0.546; 95% CI: −1.03 to 1.08) or behavioral responses (SEM change: BC +0.10 vs. EC +0.11; p = 0.971; 95% CI: −0.22 to 0.21). Conclusion The superiority trial did not reveal a statistically significant difference between the use of ethyl chloride spray and 20% benzocaine gel across any of the measured outcomes. Both anesthetic agents produced comparable physiological responses, self-reported experiences, and behavioral reactions during intra-oral local anesthetic injections in cooperative children aged 7–10 years.
ABSTRACT Objectives Managing injection pain is critical for pediatric patient cooperation. The clinical benefit of using 7.5% sodium bicarbonate‐buffered lidocaine, compared to its unbuffered counterpart, has not been extensively studied in children using a controlled split‐mouth design. Hence, this clinical trial aimed to compare the pain control efficacy of buffered versus conventional lidocaine in pediatric dentistry, assessing pain during injection, anesthetic depth, and anesthetic onset. Material and Methods A randomized, split‐mouth, crossover, double‐blind clinical trial was conducted involving 53 healthy children referred to the Kerman Dental School. Children requiring local anesthesia for the same dental procedure on two molars of the same name in one jaw were randomly assigned to Group 1 (first session: conventional 2% lidocaine; second session: buffered 2% lidocaine with 7.5% sodium bicarbonate) and Group 2 (reverse sequence). The two sessions were separated by a 1‑week washout period. Pain during injection was assessed using the SEM (Sound, Eye, Motor) scale and the FPS‐R (Facial Pain Scale‐Revised), and pulse rate changes were monitored. The SEM scale also assessed both the anesthetic onset and depth. Results Buffered lidocaine resulted in significantly lower SEM scores during injection (a 17% reduction; Exp(β) = 1.17, 95% CI [1.10, 1.23], p < 0.001) and faster anesthetic onset (a 6% improvement; Exp(β) = 1.06, 95% CI [1.01, 1.11], p = 0.011) compared with conventional lidocaine. These improvements did not extend to subjective pain scores (FPS‑R), where no significant difference was observed. Pulse rate increased similarly after the injection of either local anesthetic formulation, with no treatment‑dependent hemodynamic effect. Conclusions The administration of buffered lidocaine with 7.5% sodium bicarbonate significantly improved objective behavioral outcomes, as evidenced by lower SEM scores and a quicker onset, compared to conventional lidocaine. While these findings did not extend to subjective pain scores, the reduction in physical distress behaviors advocates for its clinical use in pediatric dental procedures. Trial Registration IRCT20241119063775N1.
Abolfazl Shiri Varnamkhasti, Sajjad Amiri, R. Shojaeipour et al.· Clinical and Experimental De...· 0 citations
Background Effective pain control is central to the pediatric dental practice. Buffering local anesthetics with sodium bicarbonate raises the solution pH to physiological levels, theoretically accelerating the onset and reducing injection discomfort. Although buffered lidocaine has been studied in children, direct evidence comparing buffered 4% articaine with the most widely used clinical alternative (non-buffered 2% lidocaine) in a pediatric outpatient setting with a comprehensive outcome assessment remains scarce. This study aimed to compare buffered 4% articaine with 1:100,000 epinephrine and non-buffered 2% lidocaine with 1:100,000 epinephrine in children aged 6–12 years requiring single-tooth dental procedures and evaluate multiple clinically relevant outcomes, including pain, anesthetic onset, operator experience, and postoperative safety. Methods This parallel-group, double-blind, randomized controlled trial enrolled 100 healthy children (American Society of Anesthesiologists (ASA) Physical Status I, aged 6–12 years). The participants were randomly allocated in a 1:1 ratio to receive either buffered 4% articaine (n = 50) or non-buffered 2% lidocaine (n = 50). The primary outcomes were injection pain (visual analog scale [VAS] score), anesthetic onset time (s), and operator-rated difficulty (VAS). Secondary outcomes included intraoperative pain, duration of soft tissue anesthesia, cardiovascular response (heart rate), behavioral cooperation (Frankl scale), pulpal success, need for reinjection, lip or cheek biting, and delayed adverse events at one week. Results Buffered articaine produced significantly lower injection pain (2.25 ± 0.94 vs. 3.93 ± 0.90; P < 0.001), faster anesthetic onset (71.98 ± 15.24 vs. 115.28 ± 20.04 s; P < 0.001), lower operator difficulty scores (2.27 ± 0.99 vs. 4.22 ± 0.98; P < 0.001), and reduced procedure pain (2.15 ± 0.99 vs. 3.56 ± 1.05; P < 0.001). Soft tissue anesthesia lasted significantly longer with buffered articaine (159.02 ± 19.10 vs. 137.84 ± 17.54 min; P < 0.001). Heart rate elevation during the injection was significantly attenuated in the articaine group (P = 0.0003). Pulpal success rates were comparable (84% vs. 82%; P = 1.000), and no significant between-group differences were observed in the reinjection rate, lip or cheek biting, or delayed adverse events. Conclusion Buffered 4% articaine provides clinically superior injection comfort, faster onset, and better behavioral cooperation than non-buffered 2% lidocaine in the pediatric dental practice, with a comparable safety profile.
Ashish Suresh, S. Tirupathi· Journal of dental anesthesia...· 0 citations
Background: Local anesthetic injections are a major source of anxiety and pain in pediatric dental patients. Various techniques have been proposed to reduce injection-related discomfort, including warming anesthetic solutions. However, limited data exist comparing the pain perception of different prewarmed dental anesthetics in children. Aim: To evaluate and compare the effect of prewarmed lidocaine and articaine solutions at 42°C on pain perception during dental local anesthetic administration in children. Materials and Methods: This randomized crossover clinical study included 20 pediatric patients requiring dental treatment. Local anesthetic solutions (lidocaine and articaine) were prewarmed to 42°C for 4 minutes before administration. Each child received one anesthetic at the first visit and the alternate anesthetic at the second visit. Pain perception during injection was assessed using the Wong-Baker FACES Pain Rating Scale. Data were analyzed using the Wilcoxon signed-rank test. Results: Both warmed anesthetic solutions resulted in reduced pain perception during injection. However, prewarmed articaine demonstrated a significantly lower mean pain score (3.90 ± 1.77) compared to prewarmed lidocaine (5.16 ± 2.03). The difference was statistically significant (P < 0.001). Conclusion: Prewarming local anesthetic solutions effectively reduces pain during dental injections in children. Among the anesthetics tested, prewarmed articaine was associated with significantly less pain on administration compared to prewarmed lidocaine, suggesting its clinical advantage in pediatric dental practice.
Y. Dheerusree, V. Chamarthi, Dhanraj Kalaivanan et al.· Genetics and Molecular Resea...· 0 citations
ABSTRACT Background Non‐sedated esophagogastroduodenoscopy (EGD) is preferred in patients at risk from sedatives. However, achieving effective pharyngeal anesthesia remains a challenge. This study compared lidocaine spray alone with a combination of lidocaine spray and viscous lidocaine solution. Methods This single‐center, randomized controlled trial was conducted between January 2024 and October 2024 at Sawanpracharak Hospital, Thailand. A total of 250 patients undergoing non‐sedated EGD were randomized to receive lidocaine spray alone (S group, n = 125) or lidocaine spray plus viscous lidocaine (S + V group, n = 125). The primary outcome was procedural pain measured using a visual analog scale (VAS, 0–10) immediately after completion of the procedure. Secondary outcomes included patient satisfaction, endoscopist satisfaction, ease of intubation, tolerance, and adverse events. Results Baseline characteristics were comparable between groups. The S + V group reported significantly lower procedural pain than the S group (mean VAS 1.6 ± 1.1 vs. 3.1 ± 1.7; p = 0.01). Patient satisfaction was higher in the S + V group (very satisfied: 23.2% vs. 12.8%; p = 0.016). Ease of intubation was also improved (effortless intubation: 43.2% vs. 29.6%; p = 0.030). Endoscopist satisfaction numerically favored the S + V group but did not reach statistical significance (p = 0.070). No serious adverse events were observed. Conclusion Combining lidocaine spray with viscous lidocaine solution significantly reduced procedural discomfort and improved procedural conditions during non‐sedated EGD compared with lidocaine spray alone. Trial Registration ClinicalTrials.gov identifier: NCT06185933
N. Faknak, Anuch Singhattha, Thidarat Inpen et al.· DEN Open· 0 citations
Aim Preventing pain and distress during peripheral intravenous cannulation in children is essential to avoid long-term anxiety or needle phobia. This study evaluated whether combining EMLA cream with the Buzzy device is more effective than EMLA alone in reducing procedural distress and pain. Materials and methods We conducted a randomized controlled trial in two tertiary children's hospitals in Italy (March-October 2023). Children aged 4–12 years requiring intravenous cannulation were randomized to receive either EMLA alone or EMLA plus Buzzy. The primary outcome was distress, assessed by parents using the Children's Emotional Manifestation Scale (CEMS). Secondary outcomes included pain measured with the Faces Pain Scale-Revised (FPS-R) by children, parents, and healthcare operators, operator-rated distress, first-attempt success, and adverse events. Analyses followed an intention-to-treat basis. Results Ninety-four children (median age 8 years) were enrolled: 47 in the EMLA plus Buzzy group and 47 in the EMLA alone group. Parent-rated distress was significantly lower with EMLA plus Buzzy (median CEMS 6, IQR 5–7) than with EMLA alone (9, IQR 7–12; p = 0.001). Pain scores and first-attempt success rates were similar. No severe adverse events occurred. Conclusion Combining EMLA and Buzzy significantly reduced procedural distress perceived by parents without affecting pain scores.
Marco Persoglia, Irene Lapucci, Egidio Barbi et al.· Frontiers in Pediatrics· 0 citations
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