Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial

The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA). In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study. A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers. Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application. Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.