The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature

Kumar, Pankaj; Thepra, Manju; Bhagol, Amrish; Priya, Kannu; Singh, Virendra

doi:10.4103/0975-5950.196137

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…The results of the present study demonstrated that the addition of DEX to LB significantly shortened the latency. This is in congruence with other studies that reported similar observations of rapid onset of anesthesia [ 9 10 11 13 15 ]. This could be due to the synergistic action of the individual drugs.…”

Section: Discussionsupporting

confidence: 93%

“…The overall difference in both groups during the procedure was statistically significant (P < 0.05). Similar observations were made by others, who noticed an increase in pain threshold values when combining DEX with lignocaine [ 11 16 ].…”

Section: Discussionsupporting

confidence: 89%

“…Perineurally administered DEX has a latency shorter than 5 min and reaches a peak effect within 15 min. Apart from longer duration of postoperative analgesia (POA), controlled hypotension (by its peripheral and central sympatholytic activity) minimal suppression of the respiratory drive, ease of administration, fewer side effects whilst preserving adequate perfusion of the vital organs has led to its utility in the maxillofacial procedures [ 9 10 11 12 13 14 15 16 ]. Blends of LB and DEX in peripheral nerve blocks have demonstrated encouraging results in transverse abdominis and brachial plexus blocks with consistently superior results; however, their efficacy in LITM surgery is a matter of investigation [ 17 18 19 20 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Patil

Jadhav

Bhola

et al. 2022

J Dent Anesth Pain Med

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Background Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 µg) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann–Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Patil

Jadhav

Bhola

et al. 2022

J Dent Anesth Pain Med

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show abstract

“…Results showed that onset and duration of anesthesia were faster and prolonged in the peripheral group as compared to other groups with insignificant hemodynamic changes amongst the groups. This study concluded that the addition of 7 mg/L dexmedetomidine to lidocaine perineurally boosts the onset of action and prolongs the duration of anesthesia [ 6 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Anaesthetic Efficacy of 2% Lignocaine With Dexmedetomidine as an Adjunct in Nerve Blocks for Dental Extractions: A Randomised Controlled Study

Suryawanshi¹,

Jadhav²,

Gupta³

et al. 2022

Cureus

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IntroductionAdequate perioperative pain control through peripheral nerve blocks is a time-honored practice. Local anesthetic (LA) alone may fail to provide desirable pain control operatively. Dexmedetomidine (DEXMED), is a relatively latest addition to the class of α agonists. The present study was deliberated with the hypothesis that addition of DEXMED to LA does not alter the potency and efficacy of lignocaine. The primary outcome variable measured was pain. Onset, depth of anesthesia, and vital parameters duration of postoperative analgesia following administration of nerve blocks with the two solutions were also measured. MethodA prospective, randomized, crossover, double-blind study was conducted on 60 systemically healthy subjects for extraction of premolars in all four quadrants. Subjects were randomly assigned to receive lignocaine mixed with epinephrine (2% lignocaine in 1:2,00,000 epinephrine) or lignocaine plus DEXMED (1μcg/ml lignocaine). On the second appointment of the study, the subjects received the other solution. Pulse rate, blood pressure, arterial oxygen saturation (SPo2), and respiratory rate were recorded as a baseline before performing, during, and two hours later. ResultsIt showed the comparison of onset of anesthesia, and duration of anesthesia in between the two groups was found to be significant (p=0.00) in Group D and Group L. Number of subjects who consumed analgesics in Group L was 34 and in Group D was 14. The hemodynamic parameters displayed no statistically significant difference from their baseline values in the two groups. ConclusionThe study concluded that dexmedetomidine when administered with lignocaine in nerve blocks provides greater hemodynamic stability and increases its anesthetic and analgesic potency making it a suitable addition to the existing list of additives for local anesthetic agents.

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“… 3 – 6 In particular, DEX has been shown to enhance the potency of a local anesthetic (eg, lidocaine) without significant systemic effects following local injection into oral mucosa. 7 The exact mechanism by which DEX prolongs local anesthetic duration has not been fully clarified. However, DEX has a direct blockade effect on tetrodotoxin-resistant sodium (Na + ) channels.…”

mentioning

confidence: 99%

Adding Dexmedetomidine to Articaine Increases the Latency of Thermal Antinociception in Rats

Tsutsui

Sunada

2020

Anesthesia Progress

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Articaine is a low-toxicity local anesthetic that is widely used in dentistry. Typically, epinephrine is added to prolong the duration of articaine local anesthesia; however, epinephrine exhibits adverse effects. Low-dose dexmedetomidine (DEX), an α2-adrenoreceptor agonist, reportedly prolongs local anesthesia without notable adverse cardiovascular effects. The purpose of this study was to assess whether a combination of low-dose DEX and articaine would provide a low-toxicity local anesthetic option for dental procedures without adverse cardiovascular effects. Thus, this study investigated whether DEX could prolong the local anesthetic effect of articaine using a rat model of pain. Adult male Wistar rats (N = 44; 11 per group) received a 50-μL subcutaneous injection into the plantar surface of the hind paws; injections were composed of either normal saline, 4% articaine (2 mg articaine), combined 5 μg/kg DEX and 4% articaine (1.25 μg DEX + 2 mg articaine), or combined epinephrine (1:100,000) and 4% articaine (0.9 μg epinephrine + 2 mg articaine). Subsequent acute pain perception was determined by paw withdrawal movement in response to infrared radiant heat stimulation of the plantar region. Paw withdrawal latency was tested at 5-minute intervals. Paw withdrawal latency values at 35 and 40 minutes were 3.83 ± 1.76 and 3.29 ± 1.43 seconds for articaine alone, 7.89 ± 2.72 and 7.25 ± 3.37 seconds for DEX and articaine, and 8.95 ± 2.28 and 8.17 ± 3.01 seconds for epinephrine and articaine. DEX prolonged the paw withdrawal latency of articaine for up to 35 minutes (p = .015) but not 40 minutes after injection (p = .052) when compared to articaine alone. The combination of DEX and articaine can provide effective local anesthesia for up to 35 minutes after injection.

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The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature

Cited by 10 publications

References 23 publications

Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Comparative Analysis of Anaesthetic Efficacy of 2% Lignocaine With Dexmedetomidine as an Adjunct in Nerve Blocks for Dental Extractions: A Randomised Controlled Study

Adding Dexmedetomidine to Articaine Increases the Latency of Thermal Antinociception in Rats

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