Article

Hemodynamic Changes Comparing 2% Lidocaine and 4% Articaine With Epinephrine 1:100,000 in Lower Third Molar Surgery

Oral and Maxillofacial Surgery, Pernambuco School of Dentistry, Universidade de Pernambuco-Faculdade de Odontologia de Pernambuco, Camaragibe, Pernambuco, Brazil.
The Journal of craniofacial surgery (Impact Factor: 0.68). 07/2012; 23(4):1204-11. DOI: 10.1097/SCS.0b013e31824f66a0
Source: PubMed

ABSTRACT An increase in blood pressure during dental treatment has been investigated with regard to potential medical risks since previous studies suggest that dental procedures may cause stress to the patient and, consequently, the cardiovascular system. The aim of the present study was to analyze hemodynamic changes following the administration of either 2% lidocaine (L100) or 4% articaine (A100) (both with epinephrine 1:100,000) in the surgical removal of symmetrically positioned lower third molars.
A prospective, randomized, double-blind, clinical trial was carried out involving 47 patients. Each patient underwent 1 surgery at each of 2 appointments--one under local anesthesia with L100 and the other with A100. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product; and pressure rate quotient.
No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, heart rate, or oxygen saturation during the surgeries. The pressure rate quotient was the only parameter to exhibit statistically significant differences between groups at different evaluation times (P < 0.05).
The hemodynamic parameters evaluated in third molar surgery with 2% lidocaine and 4% articaine (both with epinephrine 1:100,000) did not show significant differences.

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    ABSTRACT: BACKGROUND: The aim of the present study was to analyze hemodynamic changes after the administration of either 2% lidocaine with epinephrine 1:100,000 (L100) or 4% articaine with epinephrine 1:200,000 (A200) in the surgical removal of symmetrically positioned lower third molars. METHODS: A prospective, randomized, double-blind, clinical trial was carried out involving 43 patients. Each patient underwent 2 surgeries on different occasions-one under local anesthesia with L100 and the other with A200. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). RESULTS: No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, oxygen saturation or PRQ during the surgeries. Statistically significant differences between groups were detected with regard to heart rate and RPP (P < 0.05). CONCLUSIONS: The epinephrine concentration (1:100,000 or 1:200,000) and local anesthetic solutions used (2% lidocaine or 4% articaine) influenced hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.
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    ABSTRACT: BACKGROUND AND OBJECTIVES: Clinical trials comparing lidocaine associated to different epinephrine concentrations are scarce. This study aimed at comparing cardiovascular parameters, anesthetic efficacy and level of discomfort during the injection of two 2% li-docaine solutions associated to 1:100,000 or 1:200,000 epinephrine. METHODS: Participated in this cross-sectional double blind study 30 patients (24.3±4.7 years) who were submitted to anamnesis, vital signs evaluation and baseline threshold measurement of right upper canine tooth. In each clinical session, with 15 days interval, 1.8mL of one of the anesthetic solutions were administered. Anesthetic efficacy was measured with electric stimulation and vital parameters were evaluated in three periods: 5 minutes before, during and soon after anesthesia. At the end of each session, the visual analog scale was applied to evaluate injection pain sensitivity, which was repeated 24h later. RESULTS: All volunteers had satisfactory pressure levels to carry out the trial. There has been no statistically significant differences in systolic blood pressure (p=0.33), diastolic blood pressure (p=0.1505), heart rate (p=0.9464) and oxygen saturation (p=0.9297) considering each local anesthetic solution in each moment (during and after anesthesia). Formulations of 2% li-docaine with 1:100,000 and 1:200,000 epinephrine have shown no statistical differences for all anesthetic parameters (p>0.05). CONCLUSION: Considering the volume used in this study, decreased epinephrine concentration on lidocaine solution has not affected its clinical efficacy and has not influenced cardiovas-cular parameters. RESUMO JUSTIFICATIVA E OBJETIVOS: Estudos clínicos compa-rando o uso da lidocaína associada a diferentes concentrações de epinefrina na odontologia são escassos. O objetivo deste estudo foi comparar parâmetros cardiovasculares, eficácia anestésica e grau de desconforto durante a injeção de 2 soluções de lidocaína a 2% associadas a epinefrina 1:100.000 ou 1:200.000. MÉTODOS: Trinta pacientes (24,3±4,7 anos) foram incluídos (estudo cruzado e duplamente encoberto) e submetidos a anam-nese, avaliação de sinais vitais e mensuração do limiar basal do dente canino superior direito. Em cada sessão clínica, com inter-valo de 15 dias, foram administrados 1,8mL de uma das soluções anestésicas. A eficácia anestésica foi mensurada com estímulo elé-trico, e os parâmetros vitais foram avaliados em 3 períodos: 5 minutos antes, durante e logo após a anestesia. Ao final de cada sessão foi aplicada a escala analógica visual para avaliação da sen-sibilidade dolorosa da injeção, e repetida após 24h. RESULTADOS: Todos os voluntários apresentaram níveis pressóricos satisfatórios para realização do estudo. Não houve dife-renças estatisticamente significativas entre os valores de pressão arterial sistólica (p=0,33), pressão arterial diastólica (p=0,1505), frequência cardíaca (p=0,9464) e saturação de oxigênio (p=0,9297) considerando cada anestésico local em cada momento (durante e após a anestesia). As formulações de lidocaína a 2% com epinefri-na a 1:100.000 e 1:200.000 não apresentaram diferença estatística para todos os parâmetros anestésicos (p>0,05). CONCLUSÃO: Considerando o volume utilizado no presente estudo, a redução da concentração da epinefrina na solução de lidocaína não afetou sua eficácia clínica e não influenciou os parâmetros cardiovasculares. Descritores: Anestesia local, Epinefrina, Vasoconstritores.