Clinical evaluation of different epinephrine concentrations for local dental anesthesia

Caldas, Cristina; Bergamaschi, Cristiane de Cássia; Succi, Guilherme de Menezes; Motta, Rogério Heládio Lopes; Ramacciato, Juliana Cama

doi:10.5935/1806-0013.20150001

Cited by 10 publications

(10 citation statements)

References 17 publications

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“…Adrenaline, despite being a sympathomimetic amine, in this study it did not promote expressive systemic cardiovascular responses in normal patients, which confirms the reports of [2,6,14,15,16,17] and even if in literature, felypressin is indicated as the anesthetic of choice and safer for patients with cardiovascular alterations, because it causes lower cardiovascular effects [18], the use of adrenaline is justified for most dental procedures and seems to be especially important in patients suffering from cardiovascular diseases [3,5,7,19] because, in appropriate concentrations, the combination of adrenaline and local anesthesia is a guarantee of adequate levels of anesthesia and hemostasis, thus avoiding pain and consequent stress to the patient [3,8], since pain experienced during procedure may result in physiological changes that are much more significant than those caused by the addition of adrenaline to the anesthetic solution.…”

Section: Discussionsupporting

confidence: 91%

Comparison between cardiovascular effects of adrenaline and phenylephrine associated with lidocaine and the effects of felypressin with prilocaine during intrabucal anesthesia in ASA I patients

Costa

Cabral²,

Cançado

2018

Rev. Odonto Ciênc. (Online)

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OBJECTIVE: Evaluate the cardiovascular effects by infiltration of 1:100.000 epinephrine and 1:2.500 phenylephrine associated with 2% lidocaine compared with the effects by infiltration of 0.03 IU/ml felypressin with 3% prilocaine, during surgery of third molars in ASA I patients.METHODS: Eighteen patients were divided into two groups. In group I (GI), the effects of epinephrine vs felypressin were evaluated and in group II (GII), the effects of phenylephrine vs felypressin. Cardiovascular parameters: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (SatO2) were measured in pre, trans and post-operative periods.RESULTS: Statistical analysis (T-TEST) on the cardiovascular parameters demonstrated with significance that, GI: felypressin presented HR average reduction in the postoperative period and SatO2 average reduction in trans and postoperative periods. For GII: felypressin presented SatO2 average reduction in the postoperative period; SBP averages for patients submitted to phenylephrine increased in trans and postoperative periods; and DBP averages for patients submitted to phenylephrine increased in pre and trans-operative periods.COCLUSION: We can conclude that phenylephrine may lead to increased SBP and DBP and felypressin generated a reduction in HR and SatO2. All these changes were well tolerated by ASA I patients.

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Section: Discussionsupporting

confidence: 91%

Comparison between cardiovascular effects of adrenaline and phenylephrine associated with lidocaine and the effects of felypressin with prilocaine during intrabucal anesthesia in ASA I patients

Costa

Cabral²,

Cançado

2018

Rev. Odonto Ciênc. (Online)

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“…The reasons for exclusion for 51 full-text articles are listed in Table S3. The number of included trials and participants were as follows: i) maxillary buccal infiltration: 19 trials, 793 participants [ 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 ], ii) mandibular buccal infiltration: 10 trials, 465 participants [ 25 26 38 39 40 41 42 43 44 45 ], and iii) IANB: 16 trials, 477 participants [ 35 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 ].…”

Section: Resultsmentioning

confidence: 99%

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

et al. 2021

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Objectives This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. Materials and Methods Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. Results The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14–3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. Conclusions Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

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“…Andrade 19 states that the possible complications occurring after the administration of local anesthetics with epinephrine concentrations and volumes typically used in Dentistry are much smaller than the ones often occurring in the medical clinic. Moreover, diabetic patients have shown increased tolerance to vasoconstrictive agents and may benefit from small amounts of anesthetic solutions with epinephrine at a concentration of 1: 200,000 as long as the minimum dose employed is compatible with both deep and long enough anesthesia duration 5,14,19 . This study highlights another important factor as to values observed of oximetry and heart rate, since both parameters showed no statistically significant differences between groups, considering that diabetic patients may also present hypertension 1,3,12 .…”

Section: Resultsmentioning

confidence: 99%

“…For these risk patients, thorough anamneses are recommended in order to recognize their biological conditions and establish the clinical risks during the intervention 4 . Moreover, the most critical the patient's systemic condition, the more important is the effective anxiety and pain control 5 . The successful use of local anesthesia is essential for good dental treatment as well as dentist and patient interaction in order to help anxious or dental phobic patients to achieve confidence 6 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors

Mello

Ramacciato

Peruzzo

et al. 2016

RGO, Rev. Gaúch. Odontol.

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ObjectiveIn the dental clinic, the use of local anesthetics containing vasoconstrictors in diabetic patients are still controversial raising some doubts. Thus, the objective of this randomized crossover clinical trial was to evaluate blood glucose, pulse oximetry and heart rate of type 2 diabetic patients when submitted to local anesthesia using prilocaine 3% associated to felypressin 0,03UI / ml (G1) and 2% lidocaine associated to epinephrine 1: 100,000 (G2). Methods The sample consisted of 20 compensated type 2 diabetic patients (both genders) who were taking oral hypoglycemic drugs. The volunteers underwent two periodontal sessions (scaling) and one of the solutions tested was used in each visit. The cited parameters were evaluated at three different times: before the procedure (T1), 10 minutes after anesthesia (T2) and after 20 minutes (T3). Results Regarding the blood glucose levels, no statistically significant difference was found in different times between G1 and G2 (p> 0.05). Similarly, regarding pulse oximetry and heart rate, no statistically significant differences were observed in intervals assessed between groups (p> 0.05), presenting values within normal limits. Conclusion RESUMOObjetivo Na clínica odontológica, o uso de soluções anestésicas locais contendo vasoconstritores em pacientes diabéticos ainda sucita algumas dúvidas. Desta forma, o objetivo deste ensaio clínico cruzado e randomizado foi avaliar de forma comparativa a glicemia, oximetria de pulso e frequência cardíaca de pacientes portadores de diabetes tipo II quando submetidos à anestesia local com prilocaína 3% com felipressina 0,03UI/ml (G1) e lidocaína a 2% com epinefrina 1:100.000 (G2). MétodosForam selecionados 20 indivíduos diabéticos do tipo II, compensados, sem distinção de gênero, que faziam uso de hipoglicemiantes orais. Os voluntários foram submetidos a duas sessões de instrumentação periodontal, sendo administrada uma das soluções testadas em cada consulta. Os parâmetros citados foram avaliados em três momentos distintos: antes do procedimento (T1), 10 minutos após a anestesia (T2) e após 20 minutos (T3). ResultadosPara os valores de glicemia não houve diferença estatisticamente significante nos diferentes tempos entre G1 e G2 (p>0,05). Da mesma forma, em relação à oximetria de pulso e frequência cardíaca, não foram observadas diferenças estatisticamente significativas nos intervalos avaliados entre os grupos (p>0,05), com valores dentro da normalidade. ConclusãoConsiderando a concentração dos vasoconstritores e o volume das soluções anestésicas empregadas, os resultados sugerem que os vasoconstritores avaliados não alteram de forma significativa a glicemia, oximetria de pulso e frequência cardíca de adultos portadores de diabetes tipo II compensados.

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Clinical evaluation of different epinephrine concentrations for local dental anesthesia

Cited by 10 publications

References 17 publications

Comparison between cardiovascular effects of adrenaline and phenylephrine associated with lidocaine and the effects of felypressin with prilocaine during intrabucal anesthesia in ASA I patients

Comparison between cardiovascular effects of adrenaline and phenylephrine associated with lidocaine and the effects of felypressin with prilocaine during intrabucal anesthesia in ASA I patients

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors

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