Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

Abstract

The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacaine, both 0.5% and with 1 : 200,000 epinephrine. Before and after the injection, the first mandibular premolar was evaluated every 2 minutes until no response to the maximal output (80 reading) of the pulp tester and then again every 20 minutes. Data were analyzed using the Wilcoxon paired test and the paired t test. No differences were found between the solutions for onset and duration of pulpal anesthesia and duration of soft tissue anesthesia (P Ͼ .05). It was concluded that the solutions have similar anesthetic efficacy.Key Words: Bupivacaine; Levobupivacaine; Inferior alveolar nerve block; Anesthetic efficacy; Pulpal anesthesia. Racemic bupivacaine has been used as a local anesthetic in medicine and dentistry for many years. The 2 main indications for its use in dentistry are lengthy procedures and management of postoperative pain, as in endodontic, surgical, and periodontal procedures, among others.1 Although no case of toxicity has been documented in dentistry, a number of authors have reported its potent cardiac toxic effects, even in small doses.2 Studies that compared racemic bupivacaine and levobupivacaine have shown less toxicity for the latter. onset of action and prolonged analgesia with this solution than with other mixtures of bupivacaine enantiomers. Considering the lower toxicity of levobupivacaine, the purpose of this study was to compare the anesthetic efficacy of racemic bupivacaine and the mixture of 75% levobupivacaine and 25% dextrobupivacaine, both in the concentration of 0.5% with 1 : 200,000 epinephrine. METHODSThe Ethical Committee in Human Research at the Piracicaba Dentistry School, State University of Campinas, São Paulo, Brazil, approved this study; written consent was obtained from each subject. The sample size was based on a previous 6 study and confirmed by using the software nQuery Advisor 4.0 for Windows. Twenty-two subjects (9 men and 13 women) who ranged in age from 21 to 51 years (average age, 25 years) participated in this study. All the subjects were in good health, and none were taking any medication that would alter pain

Dentists' knowledge regarding signs and symptoms of the systemic toxicity of local anesthetic solutions

“…controlled diabetes, hypertension and cardiovascular diseases) is still controversial, it is thought to be appropriate to these patients provided that a proper anesthetic technique is adopt, with minimal injection of the solution (concentrations lower than or equal to 1:100,000, and a maximum of two anesthetic cartridges) and previous aspiration [12][13] . On the other hand, the use of vasoconstrictors should be avoided in patients with high risk of cardiovascular disease and uncontrolled diabetes.…”

“…The use of 3% mepivacaine without vasoconstrictor or with the vasoconstrictor felypressin (a vasopressin's synthetic analogue in association with prilocaine) can be an alternative to the use of adrenergic VCs, producing vasoconstriction in smooth muscle venules through the binding to receptors V1 and causing fewer cardiovascular side effects [5][6] . The choice of the anesthetic solution should take into account, in addition to the mechanisms of action and side effects associated with both LAs and VCs, the length of the procedure, need for hemostasis, control of postoperative pain and patients' characteristics, especially those with special needs [12][13] , on whom should be particularly observed the maximum recommended rates for these substances, presented in form of milligrams of the drug per unit of body weight.…”

A Comparative Study Between Bupivacaine with Adrenaline and Carbonated Bupivacaine with Adrenaline for Surgical Removal of Impacted Mandibular Third Molar

“…The time of onset of bupivacaine hydrochloride was 4-8 min for profound anesthesia and lower lip numbness begins after 2 min [6]. Bupivacaine hydrochloride has duration of action up to 8-10 h following nerve blocks [16,26,27]. Bupivacaine hydrochloride produces pulpal anesthesia for 90 min and is effective in controlling postsurgical pain following extraction of teeth than commonly used amide local anesthetic agent such as lidocaine.…”

The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations

“…[9][10][11][12] A number of studies have used no response to maximal electronic pulp tester output (80 reading) as a measure of pulpal anaesthesia. [13][14][15][16][17][18][19][20] Pulp anaesthesia can be defined in many ways, and with varying degrees of stringency. One method is to determine the number or percentage of subjects who obtain two or more consecutive episodes of maximal electronic pulp tester stimulation (80 reading) without response.…”