Evaluation of a Modified Two-Stage Inferior Alveolar Nerve Block Technique: A Preliminary Investigation

Introduction: The two-stage technique of inferior alveolar nerve block (IANB) administration does not address the pain associated with “needle insertion” and “local anesthetic solution deposition” in the “first stage” of the injection. This study evaluated a “modified two stage technique” to the reaction of children during “needle insertion” and “local anesthetic solution deposition” during the “first stage” and compared it to the “first phase” of the IANB administered with the standard one-stage technique. Materials and Methods: This was a parallel, single-blinded comparative study. A total of 34 children (between 6 and 10 years of age) were randomly divided into two groups to receive an IANB either through the modified two-stage technique (MTST) (Group A; 15 children) or the standard one-stage technique (SOST) (Group B; 19 children). The evaluation was done using the Face Legs Activity Cry Consolability (FLACC; which is an objective scale based on the expressions of the child) scale. The obtained data was analyzed using Fishers Exact test with the P value set at <0.05 as level of significance. Results: 73.7% of children in Group B indicated moderate pain during the “first phase” of SOST and no children indicated such in the “first stage” of group A. Group A had 33.3% children who scored “0” indicating relaxed/comfortable children compared to 0% in Group B. In Group A, 66.7% of children scored between 1–3 indicating mild discomfort compared to 26.3% in group B. The difference in the scores between the two groups in each category (relaxed/comfortable, mild discomfort, moderate pain) was highly significant (P < 0.001). Conclusion: Reaction of children in Group A during “needle insertion” and “local anesthetic solution deposition” in the “first stage” of MTST was significantly lower than that of Group B during the “first phase” of the SOST.