RU2645657C1 - Method for evaluating the effectiveness of defects in the implementation of ambulator stomatological interventions - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to dentistry. Patient and the doctor fill the analogue-visual percentage scale of pain intensity during dental surgery. Descriptors for the patient: "no pain", "weak pain", "severe pain", "very strong pain", "unbearable pain". Descriptors for the physician taking into account the pulse, blood pressure and EOD: "the clinical effect of anesthesia is expressed in full", "the clinical effect of anesthesia is close to the maximum", "the clinical effect of anesthesia is poorly expressed", "the clinical effect of anesthesia is very poorly expressed", "the clinical effect – anesthesia has not come". With a graphic mark on the patient's scale and the doctor at a level of 100 % to 90 %, the descriptors correspond to "no pain", "the clinical effect of anesthesia is expressed in full", the effectiveness of anesthesia is sufficient for painless rendering of dental care in full. With a graphic mark on the patient's scale and the doctor from less than 90 % to 80 %, the descriptors correspond to "mild pain", "the clinical effect of anesthesia is close to the maximum", the effectiveness of anesthesia is sufficient for painless rendering of dental care in full, with appropriate correction of the patient's psychoemotional state. With a graphic mark on the patient's scale and the doctor from less than 80 % to 50 %, the descriptors correspond to "severe pain", "the clinical effect of anesthesia is poorly expressed", the effectiveness of anesthesia is insufficient for painless rendering of dental care in full, the patient needs a correction of the psychoemotional state. With a graphic mark on the patient's and doctor's scale from less than 50 % to 10 % – the descriptor corresponds to "very severe pain", "the clinical effect of anesthesia is very poorly expressed", the effectiveness of the anesthesia performed is not sufficient for painless rendering of dental care, dental intervention can not be performed in full because of severe pain syndrome accompanied by both a violation of the patient's psychoemotional state and an inflammatory component at the injection site, or an unreasonable choice of the method of anesthesia and a local anesthetic drug. With a graphic mark on the patient's scale and the doctor from less than 10 % to 0 %, the descriptors correspond to "unbearable pain", and "the clinical effect – anesthesia has not come", the efficacy of the anesthesia is absent and dental interventions are impossible due to severe pain syndrome accompanied by inflammatory component at the injection site, or an unreasonable choice of the method of anesthesia and a local anesthetic drug.

EFFECT: method allows simple and reliable assessment of the effectiveness of anesthesia in performing outpatient dental interventions by using the percentage score scale filled in by the doctor and patient and evaluating the most significant indicators.

1 cl, 1 dwg, 5 ex

Description

The invention relates to medicine, in particular to dentistry, and can be used to effectively assess the intensity of pain during outpatient dental interventions.

To evaluate the effectiveness of anesthesia and characterize the intensity of pain experienced by the patient, you can objective and subjective methods of assessment. In clinical practice, a large number of subjective methods for assessing pain relief are used - various scales, questionnaires, etc. One of the most common scales is the digital rating scale (TsRSh) and the visual analogue scale - YOUR (Huskisson, ES Measurement of pain / ES Huskisson // Lancet. - 1974. - Vol. 304, Issue 7889. - P. 1127-1131.). Also, the authors of Ohnhaus EE, Adler R., 1975 and Frank AJM, Moll JMH, Hort JF, 1982 developed verbal rating scales for assessing pain intensity (Sokruta V.P., Yabluchanskaya N.I. et al. Medical rehabilitation. A textbook for students and doctors., Slavyansk, “Your Image”, 2015, chapter 2, pp. 41-42). Further, verbal descriptive pain assessment scales were developed and described (Gaston-Johansson F., Albert M., Fagan E. et al., Similarities in pain descriptions of four difterent ethnic-culture groups / Pain Symptoms Manage., 1990; 5 ( 2): 94-100) and numerical pain scales (McCaffery M., Beebe A., et al. Pain: Clinical Manual for Nursing Practice. Baltimore: VV Mosby Company, 1993). Using these scales, you can evaluate the intensity of both acute and chronic pain. The disadvantages of these scales is that the assessment of pain is based mainly on the opinion of the patient.

The scale of pain intensity is also known from the prior art, in which the indicators of the clinical effectiveness of the analgesic effect of the anesthetic, expressed in points, are converted into percentages in accordance with generally accepted practice (Sokhov ST. Clinical and experimental rationale for increasing the effectiveness of local anesthesia during outpatient dental interventions: Abstract dissertations MD / Stavropol State Medical Academy of the Ministry of Health of the Russian Federation., 1997, 41 pp.). However, insufficient clinical objectivity of the effectiveness of the analgesic effect of the anesthetic is used to assess the intensity of pain using the indicated scale.

The closest technical solution to the claimed invention is to evaluate the effectiveness of analgesia during dental interventions on an outpatient basis by means of an analog-visual scale, carried out by taking into account the patient's psychoemotional state before the intervention, namely the scale of the degree of pain experienced during the intervention and the scale of pain relief expressed in% by combining them, which provides an increase in the clinical objectivity of determining the effectiveness of pain relief Nia (RU 47680 U1, 10.09.2005).

The disadvantage of this scale is that the evaluation of the effectiveness of anesthesia is carried out only taking into account the sensations of the patient.

The technical result of the claimed method consists in expanding simple technical means for assessing the effectiveness of anesthesia when performing outpatient dental interventions with high reliability.

The technical result is achieved by the fact that the evaluation of the effectiveness of anesthesia when performing outpatient dental interventions is carried out by conducting anesthesia corresponding to the dental intervention, and evaluating the effectiveness of anesthesia using a scale with a percentage point rating, while the pain syndrome is assessed according to the conclusion of the patient and the doctor when performing a dental intervention by filling in the analog-visual percentage scale of pain intensity with descripto For the patient, “absence of pain”, “mild pain”, “severe pain”, “very severe pain”, “unbearable pain” for the patient, and for the doctor “the clinical effect of pain relief is fully expressed”: pulse and blood pressure during the intervention correspond baseline indicators; EDI is more than 100 μA, "the clinical effect of analgesia is close to maximum": EDI is from 85 to 100 μA, pulse and blood pressure during the intervention are increased from 1% to 5% with respect to the initial level, "the clinical effect of analgesia is poorly expressed": EDI - from 50 to 84 μA, pulse and blood pressure after the start of the intervention are increased from 5% to 10% relative to the initial level, "the clinical effect of pain relief is very weak": EDI - from 25 to 49 μA, pulse and blood pressure after EDI increased from 10% to 15% compared to baseline, "clinical effect - anesthesia didn’t occur ”: EDI - from 2 to 24 μA, pulse and blood pressure after EDI are increased by 15% or more compared to the initial level and with a graphic mark on the patient’s and doctor’s scale from 100% to 90%” descriptors correspond to “no pain”, “the clinical effect of analgesia is fully expressed”, the effectiveness of anesthesia is sufficient for painless dental care in full, with a graphic mark on the patient and physician scale from less than 90% to 80%, descriptors correspond to “mild pain” , "Kli the analgesic effect is close to the maximum ", the effectiveness of analgesia is sufficient for painless dental care in full, with insignificant correction of the patient's psycho-emotional state, with a graphic mark on the patient and physician scale from less than 80% to 50%, the descriptors correspond to" severe pain "," the clinical effect of analgesia is poorly expressed ", the effectiveness of analgesia is insufficient for painless provision of dental care in full, the patient needs e full correction of the psychoemotional state, with a graphic mark on the patient and doctor’s scale from less than 50% to 10% - the descriptor corresponds to “very severe pain”, “the clinical effect of pain relief is very weak”, the effectiveness of the pain relief is not sufficient for painless dental care, dental intervention cannot be performed in full due to severe pain syndrome, accompanied by both a violation of the patient's psychoemotional state, and inflame component at the injection site, or an unreasonable choice of anesthesia method and a local anesthetic drug, with a graphic mark on the patient’s and doctor’s scale from less than 10% to 0%, the descriptors correspond to “unbearable pain”, and “the clinical effect is no anesthesia”, the effectiveness of the anesthesia absent and dental interventions are impossible due to severe pain, accompanied by an inflammatory component at the injection site, or unreasonable choice of method of pain relief niya and a local anesthetic drug.

The method is as follows.

To assess the effectiveness of the anesthesia, an analog-visual scale was used to evaluate the effectiveness of anesthesia when performing outpatient dental interventions (see Fig. 1), which is filled out by both the patient and the doctor. The scale is divided into two parts: “patient” and “doctor”. To determine the intensity of pain, a percentage scale is used - from 0% to 100%, and the words are descriptors that help clarify the result. Thus, comparing the results of the responses of the doctor and the patient and finding inconsistencies in them, they either establish the patient’s unsatisfactory psycho-emotional state during treatment (his unwillingness to be treated, fear of dental treatment, etc.) and recommend that his correction be carried out, or establish that the results are inconsistent estimates of the intensity of analgesia are caused mainly by the acute inflammatory process.

The patient uses the words descriptors: “no pain”, “unbearable pain”, and between the extremes, descriptors: “mild pain”, “severe pain”, “very severe pain”. At the ends of the scale, the doctor uses the extreme limits of the depth of the onset of pain relief - “the clinical effect of pain relief is fully expressed” that is, the results of the pulse and blood pressure values correspond to the initial level indicators; and electroodontodiagnosis (EDI) is more than 100 μA, and “the clinical effect is no anesthesia has occurred”, that is, the results of the pulse and blood pressure are increased by 15% or more relative to the initial level; EDI is from 2 to 24 μA. And between the extremes, the following descriptors are used: “the clinical effect of analgesia is close to the maximum,” that is, unstable hemodynamics take place — the pulse and blood pressure during the intervention are increased from 1% to 5% with respect to the initial level; EDI - from 85 to 100 μA, "the clinical effect of analgesia is poorly expressed", that is, there is unstable hemodynamics - pulse and blood pressure are increased from 5% to 10% with respect to the initial level; EDI is from 50 to 84 μA and "the clinical effect of analgesia is very poorly expressed", that is, there is tachycardia, unstable hemodynamics - pulse and blood pressure are increased from 10% to 15% with respect to the initial level; EDI is 25 to 49 μA.

Using an analogue scale, the doctor also evaluates the patient’s psycho-emotional state and the amount of dental intervention that can be performed with one or another result of combining patient and doctor descriptors. The patient after anesthesia during a dental intervention, depending on the sensation of pain, makes an appropriate graphical mark on the scale, at the same time the doctor makes a mark on the scale, assessing the depth of anesthesia. This assessment is carried out as follows:

1. setting the percentage point indicator from 100% to 90%, which corresponds to the patient’s descriptor “no pain”, and the doctor’s descriptor “the clinical effect of pain relief is fully expressed”, that is, the depth of pain relief is sufficient for any painful dental interventions, then there is full provision of dental care will be painless, the effectiveness of anesthesia is sufficient to fully perform such painful dental interventions as: hard tooth tissues, depulpation, tooth extraction;

2. setting the percentage point indicator from less than 90% to 80%, which corresponds to the patient’s descriptor “mild pain”, and the doctor’s descriptor “the clinical effect of analgesia is close to maximum”, the effectiveness of analgesia is sufficient for painless full dental care during insignificant (for example, by the method of rational psychotherapy) correction of the patient's psychoemotional state;

3. setting the percentage point indicator at a level from less than 80% to 50%, which corresponds to the patient’s descriptor “severe pain”, and the doctor’s descriptor “the clinical effect of analgesia is poorly expressed”, the effectiveness of analgesia is insufficient for painless provision of dental care in full, and to the patient a full psycho-emotional correction is required, for example, by the method of motivational interviewing or medication;

4. setting a percentage point indicator from less than 50% to 10%, which corresponds to the patient’s descriptor “very severe pain”, and the doctor’s descriptor “the clinical effect of pain relief is very weak”, the effectiveness of the pain relief is not sufficient for painless dental care, dental the intervention cannot be performed in full due to severe pain, accompanied by both a violation of the patient's psychoemotional state and an inflammatory component that at the injection site, or unreasonable selection method analgesia and local anesthetics;

5. setting the percentage point indicator from less than 10% to 0%, which corresponds to the patient’s descriptor “unbearable pain”, and the doctor’s descriptor “clinical effect - anesthesia did not occur”, and the effectiveness of the anesthesia is absent and dental interventions are impossible due to severe pain syndrome, accompanied by an inflammatory component at the injection site, or an unreasonable choice of anesthesia method and a local anesthetic drug.

Evaluation of the effectiveness of anesthesia during outpatient dental interventions was performed in 25 patients with various dental interventions (preparation of hard tissues of the tooth, depulpation, tooth extraction).

Statistical data processing was performed using the standard software package SPSS version 20.0. For descriptive characteristics of quantitative indicators, the average sample value and standard errors were calculated. Qualitative indicators were characterized by absolute values and fractions (%). To determine the significance of differences between the quantitative indicators of different groups, we used the bilateral and Student's criterion. When analyzing the correlation dependence between the studied indicators and changes in their dynamics, non-parametric methods of correlation analysis, the Kendall criterion, were used. Significance of differences was considered significant at p <0.05. The results of studies showed in all 25 patients that the assessment of the effectiveness of analgesia and their emotional state was determined with a reliability of 95.5%.

Examples of specific performance of the method.

Example 1

Patient P., 54 years old. During planned oral cavity rehabilitation, tooth 2.6 was treated (K02.01 - dentin caries) under Sol infiltration anesthesia. Articaini hydrochloridi 4%, epinephrine 1: 200000 - 1.0 ml. Before the start of the dental intervention, the patient was anesthetized.

After the start of dental treatment, the patient and the doctor made a graphic mark on the analog-visual scale for assessing the effectiveness of anesthesia. The patient made a graphical mark at 100% - “no pain”, the doctor also made a mark at 100% - “the clinical effect of pain relief is fully expressed”: intact 2.5 EDI is 120 μA, pulse and blood pressure during the intervention correspond to the initial level. Dental intervention for dentin caries was performed in full. Thus, the results of anesthesia and a successful dental intervention indicate a high efficiency and reliability of the assessment of analgesia on an analogue-visual scale when performing outpatient dental surgery.

Example 2

Patient C, 34 years old. During planned oral cavity rehabilitation, tooth 1.6 was treated (K04.03 - chronic pulpitis) under Sol infiltration anesthesia. Articaini hydrochloridi 4%, epinephrine 1: 200000 - 1.2 ml. Before the start of dental intervention, the patient underwent an infiltration anesthesia.

After the start of dental treatment, the patient and the doctor made a graphic mark on the analog-visual scale for assessing the effectiveness of anesthesia. The patient made a graphic mark at 88% - “mild pain”, the doctor also made a mark at 89% - “the clinical effect of analgesia is close to maximum”: intact 1.5 EDI - 98 μA, pulse and blood pressure during the intervention increased by 3% in relation to the initial level. A conversation was held with the patient about the importance of this dental intervention and its necessity in order to preserve general health. Dental intervention for chronic pulpitis was performed in full. The results of the dental intervention and the correction of the patient’s psycho-emotional state indicate a high and reliable assessment of the effectiveness of analgesia on an analog-visual scale when performing outpatient dental surgery.

Example 3

Patient V., 60 years old, turned to a dental clinic for planned treatment. Under Infiltration Anesthesia Sol. Articaini hydrochloridi 4%, epinephrine 1: 200000 - 1.5 ml, 3.4 tooth was treated (K04.03 - chronic pulpitis). Before the start of dental intervention, the patient underwent an infiltration anesthesia.

After the start of dental treatment, the patient and the doctor made a graphic mark on the analog-visual scale for assessing the effectiveness of anesthesia. The patient made a graphic mark at 60% “severe pain”, the doctor made a mark at 70%, “the clinical effect of analgesia is poorly expressed”: intact 3.5–80 μA EDI, blood pressure during treatment increased by 5% compared to the initial level (130/80 increased to 136/84). The patient underwent correction of the psychoemotional state in a drug-like manner, which allowed for a complete dental intervention for chronic pulpitis. Thus, the results of the dental intervention and the correction of the patient’s psycho-emotional state indicate a high and reliable assessment of the effectiveness of analgesia on an analog-visual scale when performing outpatient dental surgery.

Example 4

Patient M., 28 years old, went to a dental clinic with acute tooth pain 3.5. Under Infiltration Anesthesia Sol. Lidocaini hydrochloridi 2%, epinephrine 1: 100000 - 1.0 ml, tooth 3.5 was treated (K04.01 - acute pulpitis). Before the start of dental intervention, the patient underwent an infiltration anesthesia.

After the start of dental treatment, the patient and the doctor made a graphic mark on the analog-visual scale for assessing the effectiveness of anesthesia. The patient made a graphical mark at the level of 0%, which corresponds to the “unbearable pain” descriptor, the doctor made a mark at the level of 0%, which corresponds to the descriptor “anesthesia did not occur”: the patient's blood pressure after EDI increased by 20% compared to the initial level EDI of intact 3.4-2 μA. Anesthesia is ineffective due to improper selection of a local anesthetic drug and method of analgesia. Conduction anesthesia (mandibular) Sol was performed. Articaini hydrochloridi 4%, epinephrine 1: 200000 - 1.7ml. After that, dental treatment was performed in full. The results indicate a high efficiency of analgesia and a reliable assessment of the effectiveness of analgesia through an analog-visual scale when performing outpatient dental surgery.

Example 5

Patient K., 34 years old. I went to the clinic about severe pain in the 3.6 tooth, notes the ineffectiveness of pain medications. The patient is characterized by motor anxiety (which indicates an increased level of anxiety). On examination: the transitional fold in the projection of teeth 3.6, 3.7 is hyperemic, a deep carious cavity on the distal contact surface of the tooth 3.6, a message is revealed with the tooth cavity. Percussion is painful. Diagnosis: K04.4 - acute apical periodontitis of pulp origin. Conducted anesthesia (torus) Sol. Articaini hydrochloridi 4%, epinephrine 1: 200000 - 1.7ml, clinical signs of the onset of pain relief (numbness of the left surface of the tongue, angle of the mouth on the left and part of the lower lip) were noted. When opening the tooth cavity, the patient complains of intolerable pain. Repeated anesthesia. The patient complains of severe pain. The patient and the doctor completed an analog-visual scale for assessing the effectiveness of pain relief. The patient made a graphic mark at 20%, which corresponds to the descriptors - "very strong pain", the doctor made a mark at 28%, which corresponds to the descriptor "the clinical effect of pain relief is very weak." This indicates an insufficient depth of anesthesia for dental treatment, treatment in full cannot be carried out. Anesthesia was ineffective due to the acute inflammatory process, an unsatisfactory psychoemotional state of the patient was noted. A means for pulp devitalization was established, the tooth was closed with a temporary filling. The results indicate a reliable assessment of the effectiveness of anesthesia through an analog-visual scale when performing outpatient dental surgery.

Thus, the method is easy to use and extends the list of technical means for assessing the effectiveness of anesthesia when performing outpatient dental interventions with high reliability.

Claims (1)

A method for evaluating the effectiveness of anesthesia when performing outpatient dental interventions, including anesthesia corresponding to a dental intervention, and evaluating the effectiveness of anesthesia using a scale with a percentage point rating, characterized in that the pain syndrome is assessed according to the conclusion of the patient and the doctor when performing a dental intervention by filling in an analog- visual percentage scale of pain intensity with descriptors for the patient "no Oli "," mild pain "," severe pain "," very severe pain "," unbearable pain ", and for the doctor," the clinical effect of anesthesia is expressed in full ": pulse and blood pressure value at the time of intervention correspond to the initial level of performance; electroodontodiagnosis (EDI) of more than 100 μA, "the clinical effect of anesthesia is close to maximum": EDI - from 85 to 100 μA, pulse and blood pressure during the intervention are increased from 1% to 5% with respect to the initial level, "the clinical effect of analgesia is expressed weak ": EDI - from 50 to 84 μA, pulse and blood pressure after the start of the intervention are increased from 5% to 10% with respect to the initial level," the clinical effect of pain relief is very weak ": EDI - from 25 to 49 μA, pulse and blood pressure after EDI increased from 10% to 15% with respect to the original level, “clinical effect - anesthesia did not occur”: EDI - from 2 to 24 μA, pulse and blood pressure after EDI are increased by 15% or more relative to the initial level and with a graphic mark on the patient and doctor’s scale from 100 % to 90% of descriptors correspond to “no pain”, “the clinical effect of anesthesia is expressed in full”, the effectiveness of anesthesia is sufficient for painless dental care in full, with a graphical mark on the patient and doctor’s scale from less than 90% to 80% descriptors respectively there are “mild pain”, “the clinical effect of anesthesia is close to maximum”, the effectiveness of anesthesia is sufficient for painless dental care in full, with appropriate correction of the patient’s psycho-emotional state, with a graphic mark on the patient’s and doctor’s scale from less than 80% to 50% descriptors correspond to "severe pain", "the clinical effect of analgesia is poorly expressed", the effectiveness of analgesia is insufficient for painless provision of dental care in full, the patient needs appropriate correction of the psychoemotional state, with a graphic mark on the patient’s and doctor’s scale from less than 50% to 10% - the descriptor corresponds to “very severe pain”, “the clinical effect of analgesia is very weak”, the effectiveness of the analgesia is not sufficient for painless rendering of dental aid, dental intervention cannot be performed in full due to severe pain syndrome, accompanied as a violation of the psycho-emotional state patient’s exposure, as well as the inflammatory component at the injection site, or unreasonable choice of anesthesia method and local anesthetic drug, with a graphic mark on the patient’s and doctor’s scale from less than 10% to 0%, the descriptors correspond to “unbearable pain”, and “the clinical effect - anesthesia did not occur ", The effectiveness of the anesthesia is absent and dental interventions are impossible due to severe pain, accompanied by an inflammatory component at the injection site, or unreasonable the choice of anesthesia method and local anesthetic drug.

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