Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

Abstract

OBJECTIVE:To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine.STUDY DESIGN:This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated.RESULTS:There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters.CONCLUSION:The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.

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

“…Regarding the results of this study, blood glucose levels remained within acceptable values for compensated diabetic patients 1,18 . Besides that there was no statistically significant difference in blood glucose levels of patients undergoing both treatments suggesting the clinical feasibility of epinephrine or felypressin administration for patients with this profile.…”

“…The use of adrenergic vasoconstrictor as epinephrine regarding local anesthesia in diabetic patients has been treated in the literature [17][18] effect of epinephrine in cellular glycogen breakdown is observed, leading to hyperglycemia Moreover, few studies have compared the effects of epinephrine and felypressin in blood glucose in diabetic patients, leading to this research.…”

“…The results of this study corroborate with Haji et al 14 and Khawaja et al 17 showing that the use of lidocaine associated to epinephrine does not present significant difference in the blood glucose alterations for compensated diabetic patients. In addition, Santos-Paul et al 18 conducted a study and demonstrated that epinephrine associated to lidocaine did not lead to hyperglycemia significant changes either in hemodynamics or in anxiety parameters in type 2 diabetic and coronary disease patients. Other studies have also observed the safe use of epinephrine as a vasoconstrictor in these patients.…”

Effect of Ketones on the Onset of Local Anesthesia among Diabetic Patients in the Kingdom of Saudi Arabia

“…14,15 In the present study, lidocaine with epinephrine was used in healthy as well as diabetic patients because it has been considered safe for use in various oral surgical procedures, when used in assessed amounts (5.4 mL) among diabetic patients regardless of whether epinephrine (1:100,000) is included. 4 In our study, the average glucose value among the subjects having controlled type I diabetes was found to be 7.3 mmol/L, and it was 15 mmol/L among those with uncontrolled type I diabetes, while it was 7.7 mmol/L among subjects with controlled type II diabetes and 13 mmol/L among those having uncontrolled type II diabetes. The American Diabetes Association defines fasting plasma glucose concentrations between 6.1 and 7 mmol/L (5.6-6.1 mmol/L blood glucose) as representing "impaired fasting glycemia."…”

“…Very serious complications, such as damage to target organs as well as microvascular abnormalities causing oral manifestations have been observed as to be related to long-term uncontrolled diabetes mellitus due to hyperglycemia. 4 Hence, diabetic people are more prone to dental and periodontal problems which the dentists are often confronted with while treating such patients. As of now, the epidemic spread of diabetes makes it most necessary for dentists to be acquainted with its knowledge and the ways of providing, to the diabetic patients, the competent professional dental care with none of the hurdles in ensuring their treatment.…”