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Comparative evaluation of the efficacy, safety, and hemostatic effect of 2% lidocaine with various concentrations of epinephrine

  • Karm, Myong-Hwan (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Minyoung (Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Park, Fiona D. (Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Seo, Kwang-Suk (Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Kim, Hyun Jeong (Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University)
  • Received : 2018.06.11
  • Accepted : 2018.06.15
  • Published : 2018.06.30

Abstract

Background: We evaluated the changes in mean arterial pressure (MAP) and heart rate (HR), and the anesthetic and hemostatic effects, after injection of 2% lidocaine containing various concentrations of epinephrine in rats and mice to determine the appropriate concentration of epinephrine in various anesthetic mixtures. Methods: Rats and mice were randomly allocated to experimental groups: 2% lidocaine without epinephrine (L0), 2% lidocaine with epinephrine 1:200,000 (L200), 1:100,000 (L100), and 1:80,000 (L80). Changes in MAP and HR after administration of the anesthetic mixture were evaluated using a physiological recording system in rats. Onset and duration of local anesthesia was evaluated by pricking the hind paw of mice. A spectrophotometric hemoglobin assay was used to quantify the hemostatic effect. Results: MAP increased in response to epinephrine in a dose-dependent manner; it was significantly higher in the L80 group than in the L0 group at 5 min post-administration. The HR was relatively lower in the L0 group than in the L80 group. The time required for onset of action was < 1 min in all evaluation groups. The duration of action and hemostatic effect of the local anesthetic were significantly better in the L200, L100, and L80 groups than in the L0 group. Conclusion: L200 demonstrated relatively stable MAP and HR values with satisfactory efficacy and hemostatic effect. L200 might be a better local anesthetic for dental patients in terms of anesthetic efficacy and safety.

Keywords

References

  1. Faccenda KA, Finucane BT. Complications of regional anaesthesia incidence and prevention. Drug Saf 2001; 24: 413-42. https://doi.org/10.2165/00002018-200124060-00002
  2. Hersh EV, Giannakopoulos H, Levin LM, Secreto S, Moore PA, Peterson C, et al. The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine. J Am Dent Assoc 2006; 137: 1562-71. https://doi.org/10.14219/jada.archive.2006.0092
  3. Sano K. Vasoconstrictors in local anesthesia. Dental Diamond 1988; 23: 62-5.
  4. Bader JD, Bonito AJ, Shugars DA. A systematic review of cardiovascular effects of epinephrine on hypertensive dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 647-53. https://doi.org/10.1067/moe.2002.123866
  5. Boonsiriseth K, Chaimanakarn S, Chewpreecha P, Nonpassopon N, Khanijou M, Ping B, et al. 4% lidocaine versus 4% articaine for inferior alveolar nerve block in impacted lower third molar surgery. J Dent Anesth Pain Med 2017; 17: 29-35. https://doi.org/10.17245/jdapm.2017.17.1.29
  6. Ping B, Kiattavorncharoen S, Durward C, Im P, Saengsirinavin C, Wongsirichat N. Hemodynamic changes associated with a novel concentration of lidocaine hcl for impacted lower third molar surgery. J Dent Anesth Pain Med 2015; 15: 121-8. https://doi.org/10.17245/jdapm.2015.15.3.121
  7. Dagher FB, Yared GM, Machtou P. An evaluation of 2% lidocaine with different concentrations of epinephrine for inferior alveolar nerve block. J Endod 1997; 23: 178-80. https://doi.org/10.1016/S0099-2399(97)80271-3
  8. Lee JY, Shin TJ, Choi JM, Seo KS, Kim HJ, Yoon TG, et al. Antinociceptive curcuminoid, kms4034, effects on inflammatory and neuropathic pain likely via modulating trpv1 in mice. Br J Anaesth 2013; 111: 667-72. https://doi.org/10.1093/bja/aet176
  9. Daublander M, Muller R, Lipp MD. The incidence of complications associated with local anesthesia in dentistry. Anesth Prog 1997; 44: 132-41.
  10. Kaufman E, Goharian S, Katz Y. Adverse reactions triggered by dental local anesthetics: A clinical survey. Anesth Prog 2000; 47: 134-8.
  11. McLure HA, Rubin AP. Review of local anaesthetic agents. Minerva Anestesiol 2005; 71: 59-74.
  12. Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for dermatologic procedures: A review. Dermatol Surg 2012; 38: 709-21. https://doi.org/10.1111/j.1524-4725.2011.02271.x
  13. Carvalho B, Fuller A, Brummel C, Cohen SE. Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: A randomized trial. Int J Obstet Anesth 2007; 16: 116-21. https://doi.org/10.1016/j.ijoa.2006.09.006
  14. Ghali S, Knox KR, Verbesey J, Scarpidis U, Izadi K, Ganchi PA. Effects of lidocaine and epinephrine on cutaneous blood flow. J Plast Reconstr Aesthet Surg 2008; 61: 1226-31. https://doi.org/10.1016/j.bjps.2007.09.011
  15. Serrera Figallo MA, Velazquez Cayon RT, Torres Lagares D, Corcuera Flores JR, Machuca Portillo G. Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies. Review of the literature published in the last decade. J Clin Exp Dent 2012; 4: e107-11.
  16. Neema C, Kapur S. Epinephrine toxicity: An avoidable fatal complication due to iatrogenic overdose. Sri Lankan J Aanesthesiol 2013; 21: 72-73. https://doi.org/10.4038/slja.v21i2.4744
  17. Salonen M, Forssell H, Scheinin M. Local dental anaesthesia with lidocaine and adrenaline. Effects on plasma catecholamines, heart rate and blood pressure. Int J Oral Maxillofac Surg 1988; 17: 392-4. https://doi.org/10.1016/S0901-5027(88)80071-7
  18. Meechan JG, Parry G, Rattray DT, Thomason JM. Effects of dental local anaesthetics in cardiac transplant recipients. Br Dent J 2002; 192: 161-3. https://doi.org/10.1038/sj.bdj.4801323
  19. Niwa H, Sugimura M, Satoh Y, Tanimoto A. Cardiovascular response to epinephrine-containing local anesthesia in patients with cardiovascular disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 610-6. https://doi.org/10.1067/moe.2001.118903
  20. Knoll-Kohler E, Frie A, Becker J, Ohlendorf D. Changes in plasma epinephrine concentration after dental infiltration anesthesia with different doses of epinephrine. J Dent Res 1989; 68: 1098-101. https://doi.org/10.1177/00220345890680060801
  21. Gerlach RF, Santos JETd, Escobar CAB. The use of epinephrine-containing anesthetic solutions in cardiac patients: A survey. Rev Odontol Univ Sao Paulo 1998; 12: 349-53. https://doi.org/10.1590/S0103-06631998000400008
  22. Wakita R, Oono Y, Oogami S, Hayashi S, Umino M. The relation between epinephrine concentration and the anesthetic effect of lidocaine iontophoresis. Pain Pract 2009; 9: 115-21. https://doi.org/10.1111/j.1533-2500.2008.00252.x
  23. Haas DA. An update on local anesthetics in dentistry. J Can Dent Assoc 2002; 68: 546-51.
  24. Yagiela JA. Vasoconstrictor agents for local anesthesia. Anesth Prog 1995; 42: 116-20.
  25. Karm MH, Park FD, Kang M, Kim HJ, Kang JW, Kim S, et al. Comparison of the efficacy and safety of 2% lidocaine hcl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase iv trial. Medicine 2017; 96: e6753. https://doi.org/10.1097/MD.0000000000006753

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