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Background <p>Inferior Alveolar Nerve Block (IANB) is the most used technique for achieving mandibular anaesthesia in dental procedures. However, conventional techniques such as the Halsted and Fischer 1-2-3 methods demonstrate variable failure rates due to anatomical variations and challenges in accurate needle placement. This study aimed to compare the anaesthetic efficacy, efficiency, and patient pain perception associated with the Angulated Needle Approach, Halsted technique, and Fischer 1-2-3 technique for IANB.</p> Materials and Methods <p>This randomized controlled trial included 93 patients requiring mandibular tooth extraction. Participants were randomly allocated into three groups (<i>n</i> = 31 each): Group I (Halsted technique), Group II (Fischer 1-2-3 technique), and Group III (Angulated Needle Approach). All groups initially received standardized anaesthetic deposition using 2% lignocaine hydrochloride with adrenaline (1:100,000). Additional anaesthetic was administered only if adequate anaesthesia was not achieved. Anaesthetic success was assessed using Sisk’s Quality of Anaesthesia Score (QAS), while intraoperative pain was evaluated using the Numerical Rating Scale (NRS). Anaesthetic volume, onset time, and complications were also recorded.</p> Results <p>The Angulated Needle Approach demonstrated the highest anaesthetic success rate (90.32%) compared with the Halsted (64.62%) and Fischer techniques (70.97%). The mean effective anaesthetic volume was significantly lower in Group III (1.69 ± 0.17&#xa0;mL; <i>p</i> &lt; 0.001). Intraoperative pain scores were also significantly lower in Group III compared with Groups I and II.</p> Conclusion <p>The Angulated Needle Approach demonstrated superior anaesthetic success, reduced anaesthetic volume requirement, and improved patient comfort compared with conventional techniques.</p> Clinical Trials Registry <p>This trial is registered at Clinical Trials Registry—India (ICMR-NIMS) with number CTRI/2024/09/073787&#xa0;[Registered on: 11/09/2024]. The design has been filed as a patent application (Application 63 No: 202441030627) with the Intellectual Property Office of India.</p>

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Comparative Evaluation of Angulated Needle, Halsted, and Fischer 1-2-3 Inferior Alveolar Nerve Block Techniques: A Randomized Controlled Trial

  • 期刊论文

  • 发表日期：

    2026年5月20日

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  • Akash Mandal,
  • Sanjay S Rao,
  • Rupinder Kaur

摘要

Background

Inferior Alveolar Nerve Block (IANB) is the most used technique for achieving mandibular anaesthesia in dental procedures. However, conventional techniques such as the Halsted and Fischer 1-2-3 methods demonstrate variable failure rates due to anatomical variations and challenges in accurate needle placement. This study aimed to compare the anaesthetic efficacy, efficiency, and patient pain perception associated with the Angulated Needle Approach, Halsted technique, and Fischer 1-2-3 technique for IANB.

Materials and Methods

This randomized controlled trial included 93 patients requiring mandibular tooth extraction. Participants were randomly allocated into three groups (n = 31 each): Group I (Halsted technique), Group II (Fischer 1-2-3 technique), and Group III (Angulated Needle Approach). All groups initially received standardized anaesthetic deposition using 2% lignocaine hydrochloride with adrenaline (1:100,000). Additional anaesthetic was administered only if adequate anaesthesia was not achieved. Anaesthetic success was assessed using Sisk’s Quality of Anaesthesia Score (QAS), while intraoperative pain was evaluated using the Numerical Rating Scale (NRS). Anaesthetic volume, onset time, and complications were also recorded.

Results

The Angulated Needle Approach demonstrated the highest anaesthetic success rate (90.32%) compared with the Halsted (64.62%) and Fischer techniques (70.97%). The mean effective anaesthetic volume was significantly lower in Group III (1.69 ± 0.17 mL; p < 0.001). Intraoperative pain scores were also significantly lower in Group III compared with Groups I and II.

Conclusion

The Angulated Needle Approach demonstrated superior anaesthetic success, reduced anaesthetic volume requirement, and improved patient comfort compared with conventional techniques.

Clinical Trials Registry

This trial is registered at Clinical Trials Registry—India (ICMR-NIMS) with number CTRI/2024/09/073787 [Registered on: 11/09/2024]. The design has been filed as a patent application (Application 63 No: 202441030627) with the Intellectual Property Office of India.