Comparative evaluation of the efficacy, safety, and hemostatic effect of 2% lidocaine with various concentrations of epinephrine

Abstract

BackgroundWe 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.MethodsRats 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.ResultsMAP 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.ConclusionL200 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.

Is prilocaine safe and potent enough for use in the oral surgery of medically compromised patients

“…Since prilocaine is also metabolized in the lungs and kidneys, it is metabolized more easily by the liver than lidocaine or mepivacaine. In addition, it clears the kidneys more rapidly than other amides 5,13…”

“…Plain prilocaine have a milder vasodilatory effect than most other amides. It can be a good choice for patients for whom vasoconstrictor is contraindicated 6,12,13. Moreover, prilocaine is less toxic than lidocaine.…”

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“…To avoid the effects of adrenaline on the circulation as much as possible, 1% lidocaine with adrenaline content adjusted to 1:400000 was used for local anesthesia in this case. However, for patients suffering from circulatory system diseases, 2% lidocaine with 1:200000 adrenalines has been recommended as the local anesthetic to prevent its effects on the cardiovascular system while achieving sufficient hemostatic and anesthetic effects [11]. Thus, a thorough and detailed discussion might be necessary, including the advisability of adrenaline use in the selection of local anesthetics, with the surgeon before the operation.…”

Does articaine, rather than prilocaine, increase the success rate of anaesthesia for extraction of maxillary teeth

“…Vasodilation results in the increased rate of absorption and reduced duration of action of anesthesia and consequently, increased anesthetic blood level and risk for toxicity. [ 9 10 11 ] Prilocaine is classified as the weakest powerful vasodilator. So, it can be useful for anesthetizing the patients who are prohibited from the use of local anesthetics with adrenaline.…”