3～12歳の小児における亜酸化窒素＋酸素および酸素吸入鎮静下での下歯槽神経ブロック中の不安の比較評価：無作為臨床試験

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.

抄録

目的:

下歯槽神経ブロック（IANB）施行時の亜酸化窒素-酸素（NO-O）吸入鎮静法を用いた小児の不安の比較評価。

AIM: A comparative evaluation of children's anxiety with the use of nitrous oxide-oxygen (NO-O) inhalation sedation during the administration of inferior alveolar nerve block (IANB).

材料と方法:

歯科処置にIANBを必要とするFranklの行動評価が2～3の3～12歳の小児計60名をこの無作為臨床試験に登録した。第I群（＝30名）には25～50％の濃度のNOと酸素吸入鎮静剤を投与し、第II群（＝30名）にはプラセボとして100％のOを投与した。脈拍数、呼吸数、血圧、酸素飽和度などの生理学的パラメータは、両群ともベースライン時、術中［局所麻酔（LA）投与中および投与後］、ガス終了後の術後に測定した。鎮静レベルは、術中（LA投与前）にRamsay Sedation Score（RSS）を用いて測定した。不快感と不安は、ベースライン時、術中、術後にFLACC（Face, Legs, Activity, Cry, Consolability）行動尺度を用いて測定した。データは統計ソフトInternational Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistics 20.0を用いて評価した。

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 ( = 30) received NO and oxygen inhalation sedation at a concentration in the range of 25-50%, whereas group II ( = 30) received 100% O as a placebo. The physiological parameters like pulse rate, respiration, blood pressure, and O 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.

結果:

FLACCスコアには、術中（-0.002）および術後（-0.049）の2群間で有意差が認められた。RSSの平均値はI群で2.80+1.03、II群で1.80+0.81であった。記録された生理学的パラメータはすべて正常範囲内であった。

RESULTS: There was a significant difference in the FLACC scores between the two groups, intraoperatively (-value-0.002), and postoperatively (-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.

結論:

NO-O吸入の使用は、IANB投与中の小児の不安レベルを改善し、O吸入と比較して有意な抗不安作用および鎮静作用を示した。

CONCLUSION: The use of NO-O inhalation improved the anxiety levels in children while receiving the IANB and showed significant anxiolytic and sedative effects as compared to O inhalation.

臨床的意義:

亜酸化窒素-酸素（NO-O）吸入は、小児に対する侵襲的治療の非薬理学的行動管理補助として、小児に最大限の安らぎを与えながら使用することができる。

CLINICAL SIGNIFICANCE: Nitrous oxide-oxygen (NO-O) inhalation can be used as a nonpharmacological behavior management adjunct for invasive treatments for children with utmost comfort for the child.

引用方法:

Thomas PS, Dave BH, Shah DJ, Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation under Inferior Alveolar Nerve Block during Anxiety in A Comparative Assessment of Anxiety under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years：無作為臨床試験。Int J Clin Pediatr Dent 2023;16(1):30-36.

HOW TO CITE THIS ARTICLE: Thomas PS, Dave BH, Shah DJ, 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.