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Patel N, B Urolagin S, Haq MA, Patel C, Bhatt R, Girdhar G, Sinha S, Haque M, Kumar S. Anesthetic Effect of 2% Amitriptyline Versus 2% Lidocaine: A Comparative Evaluation. Cureus 2023; 15:e43405. [PMID: 37581201 PMCID: PMC10423460 DOI: 10.7759/cureus.43405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/16/2023] Open
Abstract
Introduction A common dental problem is the fear of pain during needle prick for giving local anesthesia (LA). The needle prick pain during dental procedures often varies with sex and age. Perception of pain depends on various factors, which can be psychological and biological. This perception of pain may change the behavior of patients toward dental treatments. Traditionally, lidocaine gel formulation was utilized before the parenteral dosage form. The lidocaine gel formulation is considered the drug of choice for LA in dental surgery. Currently, amitriptyline has been utilized in dental practice because of its beneficial pharmacology. Hence, the present study has been undertaken to compare the anesthetic ability of amitriptyline as an intraoral topical anesthetic agent with lidocaine gel. Methods This study was a comparative clinical study between two medications' anesthetic properties. This study included 120 patients indicated for bilateral orthodontics (the subdivision of dentistry that emphasizes identifying necessary interventions for the malocclusion of teeth) procedures. All the subjects were divided into amitriptyline and lidocaine groups. Both anesthetic gels were applied at separate sites before the injection of LA. The time of the onset of anesthesia was noted and analyzed. Patients were selected on the basis of inclusion and exclusion criteria. Individuals aged 18 to 30 years who were systemically healthy and orthodontically indicated for bilateral premolar extraction were included in this study. Again, patients with a history of neurological disorders and allergies to amitriptyline and lidocaine were excluded from the current study. Results Significant differences emerged between groups at five and 10 minutes, with amitriptyline-induced partial numbness (36.7% and 6.7%). At 40 and 45 minutes, both groups showed varied partial and complete numbness, with amitriptyline leading to partial recovery (23.3% and 73.3% complete numbness, 23.3% partial recovery) and lidocaine resulting in partial recovery (81.7%). When comparing the visual analog scale (VAS) scores, both groups exhibited a similar simultaneous effect at 15 minutes. Nonetheless, amitriptyline displayed significantly lower scores at 25 and 35 minutes (p < 0.001) in comparison to lidocaine. Similar observations were made when controlling for pain intensity. Conclusion It was concluded that amitriptyline holds both anesthetic and analgesic properties. Nevertheless, this study was unable to generalize the study findings because of the small sample size and being a single-center study. However, the VAS scores of anesthetic and analgesic pharmacodynamics properties of amitriptyline were statistically significantly lower than lidocaine, particularly at 25 and 35 minutes. Additionally, amitriptyline-induced anesthetic and analgesic pharmacology, especially pharmacokinetics properties, depends on the location and pattern of pain.
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Affiliation(s)
- Nirav Patel
- Department of Oral and Maxillofacial Surgery, Goenka Research Institute of Dental Science, Gandhinagar, IND
| | - Sarvesh B Urolagin
- Department of Oral and Maxillofacial Surgery, Subbaiah Institute of Dental Sciences, Shimoga, IND
| | - Md Ahsanul Haq
- Department of Biostatistics, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BGD
| | - Chhaya Patel
- Department of Pedodontics and Preventive Dentistry, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Gaurav Girdhar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, IND
| | - Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Mainul Haque
- Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
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Motlaq VF, Adlmann FA, Hernández VA, Vorobiev A, Wolff M, Bergström LM. Dissolution mechanism of supported phospholipid bilayer in the presence of amphiphilic drug investigated by neutron reflectometry and quartz crystal microbalance with dissipation monitoring. BIOCHIMICA ET BIOPHYSICA ACTA. BIOMEMBRANES 2022; 1864:183976. [PMID: 35662645 DOI: 10.1016/j.bbamem.2022.183976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/12/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
The influence and interaction of the ionizable amphiphilic drug amitriptyline hydrochloride (AMT) on a 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) phospholipid bilayer supported on a silica surface have been investigated using a combination of neutron reflectometry and quartz crystal microbalance with dissipation monitoring. Adding AMT solutions with concentrations 3, 12, and 50 mM leaves the lipid bilayer mainly intact and we observe most of the AMT molecules attached to the head-group region of the outer bilayer leaflet. Virtually no AMT penetrates into the hydrophilic head-group region of the inner leaflet close to the silica surface. By adding 200 mM AMT solution, the lipid bilayer dissolved entirely, indicating a threshold concentration for the solubilization of the bilayer by AMT. The observed threshold concentration is consistent with the observation that various bilayer structures abruptly transform into mixed AMT-DOPC micelles beyond a certain AMT-DOPC composition. Based on our experimental observations, we suggest that the penetration of drug into the phospholipid bilayer, and subsequent solubilization of the membrane, follows a two-step mechanism with the outer leaflet being removed prior to the inner leaflet.
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Affiliation(s)
- V Forooqi Motlaq
- Department of Medicinal Chemistry, Uppsala University, P.O. Box 547, 751 23 Uppsala, Sweden; Department of Pharmacy, Uppsala University, P.O. Box 580, 75123 Uppsala, Sweden
| | - F A Adlmann
- Department of Medicinal Chemistry, Uppsala University, P.O. Box 547, 751 23 Uppsala, Sweden; Department of Pharmacy, Uppsala University, P.O. Box 580, 75123 Uppsala, Sweden
| | - V Agmo Hernández
- Department of Medicinal Chemistry, Uppsala University, P.O. Box 547, 751 23 Uppsala, Sweden
| | - A Vorobiev
- Division for Materials Physics, Department of Physics and Astronomy, Uppsala University, Box 516, 751 20 Uppsala, Sweden
| | - M Wolff
- Division for Materials Physics, Department of Physics and Astronomy, Uppsala University, Box 516, 751 20 Uppsala, Sweden
| | - L M Bergström
- Department of Medicinal Chemistry, Uppsala University, P.O. Box 547, 751 23 Uppsala, Sweden; Department of Pharmacy, Uppsala University, P.O. Box 580, 75123 Uppsala, Sweden.
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Gholami M, Torabi Davan S, Gholami M, Bolandparvaz S, Gholami M, Chamanpara P, Shayan L. Effects of Topical Sesame Oil Extracted from Tahini ( Ardeh) on Pain Severity in Trauma Patients: A Randomized Double-Blinded Placebo-Controlled Clinical Trial. Bull Emerg Trauma 2020; 8:179-185. [PMID: 32944578 PMCID: PMC7468223 DOI: 10.30476/beat.2020.82561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the effects of sesame oil extracted from tahini (Ardeh) on pain severity in patients with upper or lower limbs trauma. Methods This double-blinded randomized clinical trial study was conducted on 120 patients with upper or lower trauma in Shahid Rajaee Hospital, Shiraz, Iran, from May the 1st through November 30th, 2016. The patients were randomly assigned to two groups using block randomization. The intervention group received topical sesame oil extracted from tahini (Ardeh) and the placebo group received cooking oil. Pain severity, pain sensitivity and heaviness of painful site were assessed. Results Overall, we included 90 patients with traumatic limb injuries in this study who were randomized to two study groups. The mean age of the patients was 28.3 ± 6.8 (ranging from 25 to 35) years and there were 63 (70%) men and 27 (30%) women among the patients. In the sesame oil group, the mean changes in the pain severity (-1.53 ± 0.57, P<0.001), pain sensitivity (-1.45 ± 0.64, P<0.001) and heaviness of painful site (-1.56 ± 0.68, P<0.001) were significantly lower when compared to the placebo group in the second day of the intervention. None of the patients experience adverse drug effects. Conclusion Our findings suggest that the topical use of sesame oil extracted from Tahini has a pain reliever effect on the skin after bruising and it helps prevent skin discoloration in patients with traumatic injuries of limbs.
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Affiliation(s)
- Maryam Gholami
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Torabi Davan
- Transplantation Unit, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Gholami
- Intensive Care Unit, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Bolandparvaz
- Trauma Research Center, Department of Surgery, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnaz Gholami
- School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Cognitive Neuroscience, Institute for Cognitive Science Studies, Shahid Beheshti University, Tehran, Iran; Cognitive Science (Brain, Mind, and Education), Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Parisa Chamanpara
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Shayan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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