Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Does the presence and amount of epinephrine in 2% lidocaine affect its anesthetic efficacy in the management of symptomatic maxillary molars with irreversible pulpitis?

  • Singla, Mamta (Department of Conservative Dentistry & Endodontics, SGT Dental College) ;
  • Gugnani, Megha (Department of Conservative Dentistry & Endodontics, SGT Dental College) ;
  • Grewal, Mandeep S (Department of Conservative Dentistry & Endodontics, SGT Dental College) ;
  • Kumar, Umesh (Division of Conservative Dentistry and Endodontics, Post Graduate Institute of Medical Sciences) ;
  • Aggarwal, Vivek (Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia)
  • Received : 2021.10.29
  • Accepted : 2021.12.20
  • Published : 2022.02.01
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Abstract

Background: This was a randomized controlled clinical trial that aimed to evaluate the anesthetic efficacy of 2% lidocaine combined with different concentrations of epinephrine (plain, 1:200,000 and 1:80,000) during endodontic treatment of maxillary molars with symptomatic irreversible pulpitis. Methods: The trial included 144 adult patients who were randomly allocated to three treatment groups. All patients received buccal-plus-palatal infiltration. After 10 min, pulp sensibility testing was performed using an electric pulp test (EPT). If a tooth responded positively, anesthesia was considered to have failed. In the case of a negative EPT response, endodontic access was initiated under rubber dam isolation. The success of anesthesia was defined as having a pain score less than 55 on the Heft Parker visual analog scale (HP VAS), which was categorized as 'no pain' or 'faint/weak/mild' pain on the HP VAS. Baseline pre-injection and post-injection maximum heart rates were recorded. The Pearson chi-square test was used to analyze the anesthetic success rates at 5% significance. Results: Plain 2% lidocaine and 2% lidocaine with 1:200,000 epinephrine and 1:80,000 epinephrine had anesthetic success rates of 18.75%, 72.9%, and 82.3%, respectively. Statistical analysis indicated significant differences between the groups (P < 0.001, 𝛘2 = 47.5, df = 2). The maximum heart rate increase was seen with 2% lidocaine solution with epinephrine. Conclusion: Adding epinephrine to 2% lidocaine significantly improves its anesthetic success rates during the root canal treatment of maxillary molars with symptomatic irreversible pulpitis.

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References

  1. Guglielmo A, Drum M, Reader A, Nusstein J. Anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar. J Endod 2011; 37: 460-2. https://doi.org/10.1016/j.joen.2011.01.005
  2. Pfeil L, Drum M, Reader A, Gilles J, Nusstein J. Anesthetic efficacy of 1.8 milliliters and 3.6 milliliters of 2% lidocaine with 1:100,000 epinephrine for posterior superior alveolar nerve blocks. J Endod 2010; 36: 598-601. https://doi.org/10.1016/j.joen.2010.01.009
  3. Aggarwal V, Singla M, Miglani S, Ansari I, Kohli S. A prospective, randomized, single-blind comparative evaluation of anesthetic efficacy of posterior superior alveolar nerve blocks, buccal infiltrations, and buccal plus palatal infiltrations in patients with irreversible pulpitis. J Endod 2011; 37: 1491-4. https://doi.org/10.1016/j.joen.2011.08.018
  4. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics:. Mechanisms and Management. Endod Topics 2002; 1: 26-39. https://doi.org/10.1034/j.1601-1546.2002.10103.x
  5. Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod 2012; 38: 421-5. https://doi.org/10.1016/j.joen.2011.12.006
  6. Evans G, Nusstein J, Drum M, Reader A, Beck M. A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations. J Endod 2008; 34: 389-93. https://doi.org/10.1016/j.joen.2008.01.004
  7. Mason R, Drum M, Reader A, Nusstein J, Beck M. A prospective, randomized, double-blind comparison of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine for maxillary infiltrations. J Endod 2009; 35: 1173-7. https://doi.org/10.1016/j.joen.2009.06.016
  8. Aggarwal V, Singla M, Miglani S, Kohli S. Comparison of the anaesthetic efficacy of epinephrine concentrations (1 : 80 000 and 1 : 200 000) in 2% lidocaine for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized, double-blind clinical trial. Int Endod J 2014; 47: 373-9. https://doi.org/10.1111/iej.12157
  9. Soysa NS, Soysa IB, Alles N. Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: a systematic review and meta-analysis. J Investig Clin Dent 2019; 10: e12404.
  10. Pitt Ford TR, Seare MA, McDonald F. Action of adrenaline on the effect of dental local anaesthetic solutions. Endod Dent Traumatol 1993; 9: 31-5. https://doi.org/10.1111/j.1600-9657.1993.tb00457.x
  11. Heft MW, Parker SR. An experimental basis for revising the graphic rating scale for pain. Pain 1984; 19: 153-61. https://doi.org/10.1016/0304-3959(84)90835-2
  12. Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 2004; 30: 568-71. https://doi.org/10.1097/01.DON.0000125317.21892.8F
  13. Susi L, Reader A, Nusstein J, Beck M, Weaver J, Drum M. Heart rate effects of intraosseous injections using slow and fast rates of anesthetic solution deposition. Anesth Prog 2008; 55: 9-15. https://doi.org/10.2344/0003-3006(2008)55[9:HREOII]2.0.CO;2
  14. Nusstein J, Claffey E, Reader A, Beck M, Weaver J. Anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in patients with irreversible pulpitis. J Endod 2005; 31: 354-8. https://doi.org/10.1097/01.DON.0000140565.88940.60
  15. Brunetto PC, Ranali J, Ambrosano GM, de Oliveira PC, Groppo FC, Meechan JG, et al. Anesthetic efficacy of 3 volumes of lidocaine with epinephrine in maxillary infiltration anesthesia. Anesth Prog 2008; 55: 29-34. https://doi.org/10.2344/0003-3006(2008)55[29:AEOVOL]2.0.CO;2
  16. Mikesell A, Drum M, Reader A, Beck M. Anesthetic efficacy of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltrations. J Endod 2008; 34: 121-5. https://doi.org/10.1016/j.joen.2007.11.001
  17. Scott J, Drum M, Reader A, Nusstein J, Beck M. The efficacy of a repeated infiltration in prolonging duration of pulpal anesthesia in maxillary lateral incisors. J Am Dent Assoc 2009; 140: 318-24. https://doi.org/10.14219/jada.archive.2009.0161
  18. Chaudhary P, Martenson ME, Baumann TK. Vanilloid receptor expression and capsaicin excitation of rat dental primary afferent neurons. J Dent Res 2001; 80: 1518-23. https://doi.org/10.1177/00220345010800060801
  19. Stenholm E, Bongenhielm U, Ahlquist M, Fried K. VRl-and VRL-l-like immunoreactivity in normal and injured trigeminal dental primary sensory neurons of the rat. Acta Odontol Scand 2002; 60: 72-9. https://doi.org/10.1080/000163502753509455
  20. Aberg G. Studies on the duration of local anesthesia: A possible mechanism for the prolonging effect of "vasoconstrictors" on the duration of infiltration anesthesia. Int J Oral Surg 1980; 9: 144-7. https://doi.org/10.1016/s0300-9785(80)80051-2
  21. Naftalin LW, Yagiela JA. Vasoconstrictors: indications and precautions. Dent Clin North Am 2002; 6: 733-46. https://doi.org/10.1016/S0011-8532(02)00021-6
  22. Gomez-Moreno G, Guardia J, Cutando A, Calvo-Guirado JL. Pharmacological interactions of vasoconstrictors. Med Oral Patol Oral Cir Bucal 2009; 14: E20-7.
  23. Goulet JP, Perusse R, Turcotte JY. Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions. Oral Surg Oral Med Oral Pathol 1992; 74: 692-7. https://doi.org/10.1016/0030-4220(92)90367-Y
  24. Perusse R, Goulet JP, Turcotte JY. Contraindications to vasoconstrictors in dentistry: Part I. Cardiovascular diseases. Oral Surg Oral Med Oral Pathol 1992; 74: 679-86. https://doi.org/10.1016/0030-4220(92)90365-W
  25. Meral G, Tasar F, Sayin F, Saysel M, Kir S, Karabulut E. Effects of lidocaine with and without epinephrine on plasma epinephrine and lidocaine concentrations and hemodynamic values during third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: e25-30. https://doi.org/10.1016/j.tripleo.2005.03.031
  26. Knoll-Kohler E, Fortsch G. Pulpal anesthesia dependent on epinephrine dose in 2% lidocaine. A randomized controlled double-blind crossover study. Oral Surg Oral Med Oral Pathol 1992; 73: 537-40. https://doi.org/10.1016/0030-4220(92)90091-4
  27. 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
  28. McEntire M, Nusstein J, Drum M, Reader A, Beck M. Anesthetic efficacy of 4% Articaine with 1:100,000 epinephrine versus 4% articaine with 1:200,000 epinephrine as a primary buccal infiltration in the mandibular first molar. J Endod 2011; 37: 450-4. https://doi.org/10.1016/j.joen.2010.12.007
  29. Kyosaka Y, Owatari T, Inokoshi M, Kubota K, Inoue M, Minakuchi S. Cardiovascular comparison of 2 types of local anesthesia with vasoconstrictor in older adults: a crossover study. Anesth Prog 2019; 66: 133-40. https://doi.org/10.2344/anpr-66-02-04
  30. Aggarwal V, Jain A, Kabi D. Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 2009; 35: 925-9. https://doi.org/10.1016/j.joen.2009.04.012
  31. Hosseini HR, Parirokh M, Nakhaee N, V Abbott P, Samani S. Efficacy of articaine and lidocaine for buccal infiltration of first maxillary molars with symptomatic irreversible pulpitis: a randomized double-blinded clinical trial. Iran Endod J 2016; 11: 79-84.
  32. Moradi Askari E, Parirokh M, Nakhaee N, Hosseini HR, Abbott PV. The effect of maxillary first molar root length on the success rate of buccal infiltration anesthesia. J Endod 2016; 42: 1462-6. https://doi.org/10.1016/j.joen.2016.07.005