Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery

Alam, Shahbaz; Krishna, Bhavya; Kumaran, Santosh; Prasad, Sham; Biddappa, M A Lakshith; Kalappa, T M; Gowtham, S; Ahmed, Naveed

doi:10.4103/ams.ams_256_18

Cited by 3 publications

(7 citation statements)

References 17 publications

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“…Out of these, 16 articles were excluded due to various reasons listed in Table 1 . [ 13 – 33 ] Subsequently, five studies qualified for systematic review[ 14 , 18 , 20 , 27 , 28 ] out of which meta-analysis was performed in four studies. [ 14 , 18 , 20 , 27 , 28 ] A flowchart of the search results is presented in Figure 1 .…”

Section: R Esultsmentioning

confidence: 99%

“…Amongst them, only two studies are double-blind studies[ 18 , 27 ] and the rest are clinical observational studies. [ 14 , 20 , 28 ] In total, 350 patients with ages ranging from 18 to 70 years received nerve block dental lignocaine injections with either clonidine or adrenaline as vasoconstrictors. Mandibular third molars were extracted under IANB in four studies.…”

Section: R Esultsmentioning

confidence: 99%

“…Mandibular third molars were extracted under IANB in four studies. [ 14 , 20 , 27 , 28 ] One study evaluated the same in maxillary third molar removal under posterior superior alveolar nerve block and greater palatine nerve block. [ 18 ] All the five included studies evaluated haemodynamic parameters such as heart rate, systolic, diastolic blood pressure and mean arterial blood pressure at three intervals (baseline pre-operative, intraoperative and post-operative).…”

Section: R Esultsmentioning

confidence: 99%

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Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis

Afnan

Tirupathi

Alahari

et al. 2022

Annals of Maxillofacial Surgery

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Background: Adrenaline or clonidine is used as adjuncts in conjunction with lignocaine to improve the depth of local anaesthesia in dental procedures. Objectives: This systematic review and meta-analysis intends to compare the haemodynamic parameters when clonidine or adrenaline is used in conjunction with lignocaine for third-molar surgical removal. Data Sources: Cochrane, PubMed and Ovid SP databases were searched using “MeSH” terms (((nerve block) OR (IANB)) AND ((clonidine) OR (adrenaline))) AND (lignocaine) . Study Eligibility Criteria: Clinical studies where Clonidine + lignocaine and Adrenaline + lignocaine were compared directly during nerve block administration exclusively for third molar surgical removal were selected. Participants, Study Appraisal: This current systematic review is registered in Prospero database CRD42021279446. Two independent reviewers were involved in collection, segregation and analysis of electronic data. The data were compiled in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search was conducted till June 2021. Synthesis Methods: Qualitative analysis of the selected articles was performed for systematic review. Meta-analysis is performed using RevMan 5 Software. Heterogeneity through the I 2 statistics. Change in the haemodynamic parameters was the primary outcome evaluated, and secondary outcomes evaluated were onset and duration of anaesthesia in both the groups. Results: In all databases, 1141 records were screened, out of which a total of 21 articles were included for the evaluation for full-text analysis. Out of these, 16 articles were excluded and 5 articles were included for the final systematic review. Meta-analysis was performed only for 4 studies. Conclusion: Amongst the evaluated haemodynamic parameters, there was a significant reduction in the heart rate (baseline to intraoperative period) in clonidine and lignocaine groups than in adrenaline and lignocaine groups during nerve block administration for third molar surgical removal. There was no significant difference between other primary and secondary outcomes evaluated. Limitations: Blinding was not performed in all the studies, randomisation was performed in only three studies. The volume of local anaesthesia deposited varied in the studies (2 mL in three studies and 2.5 mL in two studies). Most of the studies ( n = 4) were evaluated on normal adults and only one study evaluated mild hypertensive patients.

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Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

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Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis

Afnan

Tirupathi

Alahari

et al. 2022

Annals of Maxillofacial Surgery

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“…The most commonly used local anesthetic agent in dentistry is lignocaine hydrochloride. However, due to its vasodilator properties,[ 1 ] a vasoconstrictor needs to be added to prolong duration of anesthetic action, to reduce systemic absorption, thereby reducing the systemic toxicity of lignocaine and to provide hemostasis. Adrenaline, a potent vasoconstrictor, serves to achieve these effects.…”

Section: Introductionmentioning

confidence: 99%

“…Adrenaline, a potent vasoconstrictor, serves to achieve these effects. [ 1 ] The commonly available local anesthetic solutions contain adrenaline bitartrate in different concentrations, ranging from 12.5 μg/ml (1:80,000) to 5 μg/ml (1:200,000). Even with small doses of adrenaline, there are significant cardiovascular changes in both healthy and cardiac patients.…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of effectiveness of 2% lignocaine hydrochloride with clonidine hydrochloride versus 2% lignocaine hydrochloride with adrenaline bitartrate as local anesthetic for adult patients undergoing surgical extraction of impacted mandibular third molars: A randomized controlled clinical study

et al. 2021

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Background and Objectives: Clonidine is a common additive to local anesthetics for various regional and local nerve blocks. However, its effectiveness in dentistry has not yet been fully explored. Thus, this study was performed to evaluate the quality of anesthesia, vasoconstrictive effects, hemodynamic response, and pain control using a solution of 2% lignocaine hydrochloride with clonidine hydrochloride in comparison with the standard solution of 2% lignocaine hydrochloride and adrenaline bitartrate for pterygomandibular nerve blocks. Materials and Methods: A parallel arm, triple-blind randomized controlled study was conducted on 152 patients belonging to ASA-I (American Society of Anesthesiologists) category in the age group of 18-45 years, requiring surgical extraction of impacted mandibular third molars. The patients were divided equally into two groups randomly by computer-generated sequence; Group 1: 2% lignocaine hydrochloride with 1 ml of clonidine hydrochloride (150 μg/ml) and Group 2: 2% lignocaine hydrochloride with adrenaline bitartrate 1: 80,000 (12.5 μg/ml). The variables evaluated were systolic, diastolic, and mean arterial blood pressures, heart rate (HR), blood loss, onset, depth (pain), and duration of anesthesia. Results: There was a statistically nonsignificant difference seen between the two groups ( P > 0.05) for the onset of anesthesia, pain assessed, and blood loss, whereas a statistically highly significant difference was seen for cardiovascular variables (systolic, diastolic and mean arterial blood pressures, and HR) at various intervals with higher values for Group 2 ( P < 0.001) and for the duration of action of local anesthesia (LA), with higher values for Group 1 ( P < 0.001). Conclusions: Clonidine as an additive to lignocaine has proved to have the onset of action, vasoconstrictive properties, and pain control, equivalent to adrenaline. However, with better stability of hemodynamic variables and prolonged duration of action of LA with clonidine, it can be considered as a better, safer, and more effective additive to lignocaine than adrenaline

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Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a randomized controlled trial

Doshi,

Bhola,

Agarwal

2024

J Dent Anesth Pain Med

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Background In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. Methods This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson’s Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 µg/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 µg/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Results Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Conclusion Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

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Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery

Cited by 3 publications

References 17 publications

Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis

Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis

Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a randomized controlled trial

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