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Aliabadi E, Divanpour V, Mardani M. Changes in Blood Pressure and Pulse Rate of Patients without Systemic Diseases Following the Injection of 2% Lidocaine Plus Epinephrine 1:80000 in an Inferior Alveolar Nerve Block - A Prospective Study. Ann Maxillofac Surg 2020; 10:361-364. [PMID: 33708580 PMCID: PMC7943989 DOI: 10.4103/ams.ams_187_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/27/2020] [Accepted: 04/18/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction An inferior alveolar nerve block is dental anesthesia produced by the local injection of lidocaine plus epinephrine; however, its administration could cause cardiovascular side effects. We aimed to assess the changes in blood pressure and pulse rate following the injection of 2% lidocaine with epinephrine 1:80000 for an inferior alveolar nerve block. Materials and Methods Seventy-one patients without any systemic disease were enrolled in this study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate were measured using an automatic digital blood pressure monitor in four stages as follows: at the rest time (Stage 1), prior to injection (Stage 2), immediately after injection (Stage 3), and 10 min after the administration of anesthetic agents (Stage 4). All injections and measurements were carried out by a single operator to minimize the variability. Results SBP and DBP in all stages were within the normal range (lower than 130 and 80 mmHg, respectively), and none of the patients showed evidence of arterial hypertension. Although the pulse rate increased significantly at Stages 2, 3, and 4 compared with Stage 1 (P < 0.05), no evidence of bradycardia or tachycardia was seen. Discussion Local anesthesia with 2% lidocaine plus epinephrine 1:80000 for an inferior alveolar nerve block would be safe for patients without any systemic diseases.
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Affiliation(s)
- Ehsan Aliabadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Divanpour
- Department of Operative Dentistry, Bushehr University of Medical Sciences, Iran
| | - Mohsen Mardani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Sayphiboun P, Boonsiriseth K, Mahardawi B, Pairuchvej V, Bhattarai BP, Wongsirichat N. The anesthetic efficiency of retromolar infiltrations with two local anesthetic solutions of the same concentration in lower third molar surgery. J Dent Anesth Pain Med 2020; 20:137-146. [PMID: 32617408 PMCID: PMC7321737 DOI: 10.17245/jdapm.2020.20.3.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/16/2020] [Accepted: 06/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background Mandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery. Methods This double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded. Results The results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar. Conclusion It is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.
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Affiliation(s)
- Phouthala Sayphiboun
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kiatanant Boonsiriseth
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Basel Mahardawi
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Karm MH, Kim M, Park FD, Seo KS, Kim HJ. Comparative evaluation of the efficacy, safety, and hemostatic effect of 2% lidocaine with various concentrations of epinephrine. J Dent Anesth Pain Med 2018; 18:143-149. [PMID: 29984318 PMCID: PMC6031971 DOI: 10.17245/jdapm.2018.18.3.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We evaluated the changes in mean arterial pressure (MAP) and heart rate (HR), and the anesthetic and hemostatic effects, after injection of 2% lidocaine containing various concentrations of epinephrine in rats and mice to determine the appropriate concentration of epinephrine in various anesthetic mixtures. METHODS Rats and mice were randomly allocated to experimental groups: 2% lidocaine without epinephrine (L0), 2% lidocaine with epinephrine 1:200,000 (L200), 1:100,000 (L100), and 1:80,000 (L80). Changes in MAP and HR after administration of the anesthetic mixture were evaluated using a physiological recording system in rats. Onset and duration of local anesthesia was evaluated by pricking the hind paw of mice. A spectrophotometric hemoglobin assay was used to quantify the hemostatic effect. RESULTS MAP increased in response to epinephrine in a dose-dependent manner; it was significantly higher in the L80 group than in the L0 group at 5 min post-administration. The HR was relatively lower in the L0 group than in the L80 group. The time required for onset of action was < 1 min in all evaluation groups. The duration of action and hemostatic effect of the local anesthetic were significantly better in the L200, L100, and L80 groups than in the L0 group. CONCLUSION L200 demonstrated relatively stable MAP and HR values with satisfactory efficacy and hemostatic effect. L200 might be a better local anesthetic for dental patients in terms of anesthetic efficacy and safety.
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Affiliation(s)
- Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Minyoung Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Fiona D. Park
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Lee J, Lee JY, Kim HJ, Seo KS. Dental anesthesia for patients with allergic reactions to lidocaine: two case reports. J Dent Anesth Pain Med 2017; 16:209-212. [PMID: 28884155 PMCID: PMC5586559 DOI: 10.17245/jdapm.2016.16.3.209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 12/03/2022] Open
Abstract
Lidocaine, a local anesthetic commonly used in dental treatments, is capable of causing allergies or adverse effects similar to allergic reactions. However, the frequency of such occurrences in actual clinical settings is very rare, and even clinical tests on patients with known allergies to local anesthetics may often show negative results. When adverse effects, such as allergy to lidocaine, are involved, patients can be treated by testing other local anesthetics and choosing a local anesthetic without any adverse effects, or by performing dental treatment under general anesthesia in cases in which no local anesthetic without adverse effects is available. Along with a literature review, the authors of the present study report on two cases of patients who tested positive on allergy skin tests for lidocaine and bupivacaine and subsequently underwent successful dental treatments with either general anesthesia or a different local anesthetic.
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Affiliation(s)
- Jiseon Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Ju-Young Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Raocharernporn S, Boonsiriseth K, Khanijou M, Wongsirichat N. Hemodynamic changes and pain perception-related anxiety after experiencing an impacted-tooth removal: clinical practice outcome. J Dent Anesth Pain Med 2017; 17:105-111. [PMID: 28879337 PMCID: PMC5564143 DOI: 10.17245/jdapm.2017.17.2.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/03/2017] [Accepted: 04/09/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status. METHODS Twenty-seven healthy patients aged 15-30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used. RESULTS The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05). CONCLUSIONS There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.
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Affiliation(s)
- Somchart Raocharernporn
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kiatanant Boonsiriseth
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Manop Khanijou
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Karm MH, Park FD, Kang M, Kim HJ, Kang JW, Kim S, Kim YD, Kim CH, Seo KS, Kwon KH, Kim CH, Lee JW, Hong SW, Lim MH, Nam SK, Cho JM. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial. Medicine (Baltimore) 2017; 96:e6753. [PMID: 28538371 PMCID: PMC5457851 DOI: 10.1097/md.0000000000006753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. METHODS Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups. RESULTS There were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01). CONCLUSION The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.
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Affiliation(s)
| | - Fiona Daye Park
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Moonkyu Kang
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Jeong Wan Kang
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul
| | - Seungoh Kim
- Department of Dental Anesthesiology, Dankook University College of Dentistry, Dankook University, Cheonan-si, Chungnam
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University and Institute of Translational Dental Sciences, Pusan National University
| | - Cheul-Hong Kim
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Gyeongnam
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Kyung-Hwan Kwon
- College of Dentistry, Wonkwang University, Iksan city, Jeonbuk
| | - Chul-Hwan Kim
- Department of Oral and Maxillofacial Surgery, Dankook University College of Dentistry, Dankook University, Cheonan-si, Chungnam
| | - Jung-Woo Lee
- Department of Oral & Maxillofacial Surgery, Kyung Hee University Dental Hospital Kyung Hee University School of Dentistry, Seoul
| | - Sung-Woon Hong
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
| | - Mi Hyoung Lim
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
| | - Seung Kwan Nam
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
| | - Jae Min Cho
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
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Boonsiriseth K, Chaimanakarn S, Chewpreecha P, Nonpassopon N, Khanijou M, Ping B, Wongsirichat N. 4% lidocaine versus 4% articaine for inferior alveolar nerve block in impacted lower third molar surgery. J Dent Anesth Pain Med 2017; 17:29-35. [PMID: 28879326 PMCID: PMC5564134 DOI: 10.17245/jdapm.2017.17.1.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. Method This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. Results The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. Conclusion The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.
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Affiliation(s)
- Kiatanant Boonsiriseth
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sittipong Chaimanakarn
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Prued Chewpreecha
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natee Nonpassopon
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Manop Khanijou
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Bushara Ping
- Faculty of Odonto-Stomatology, University of Health Sciences of Cambodia (UHS), Cambodia
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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