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

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.

Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review

“…Ping et al 33 suggested that IANB using 4L100 was more effective than that using 2L100, and epinephrine is an excellent vasoconstrictor with varying degrees of efficiency, depending on the concentration of epinephrine added to lidocaine. 34 Three studies reported that the dosage of anesthesia could affect the efficiency of anesthesia, in that a greater volume could increase anesthetic efficiency. [28][29][30] This is because a higher volume of the anesthetic agent may yield a higher concentration of the anesthetic agent in the pterygomandibular space.…”

Regional anesthesia with epinephrine‐containing lidocaine reduces pericatheter bleeding after tunneled hemodialysis catheter placement

“…Traditionally, subcutaneous infiltration of epinephrine‐containing lidocaine was safely and routinely used in craniotomy to reduce blood flow in the scalp and minimize intraoperative blood loss . We can see similar studies, especially in the past, in the field of dermatology and dentistry . In our study, we used epinephrine‐containing local anesthetics in THC placement procedure.…”

“…There was no difference between the groups with epinephrine at 1:80,000 concentrations and 1:200,000 concentrations in terms of both adverse effect and efficacy (2.0 ± 0.1 in the L80 group and 2.2 ± 0.1 in the L200 group, P = 0.206). Therefore, it was concluded that use of the epinephrine at 1:200,000 in hemodynamically unstable patients is safer . We used 1:80,000 concentration of epinephrine and found it to be successful; the same study can be done with different doses of epinephrine and the procedure can be drawn to much safer doses.…”

“…24,25 We can see similar studies, especially in the past, in the field of dermatology and dentistry. 6,12,16,20,26 In our study, we used The variable "RAD" represents "prilocaine" b Odds ratio (OR) for epinephrine-containing lidocaine in the likelihood of PB is 0.017 (1/59.571). OR = odds radio; CI = confidence interval; RAD = regional anesthetic drug; aPTT = activated partial thromboplastin time; INR = international normalized ratio; SBP = systolic blood pressure.…”

“…Therefore, it was concluded that use of the epinephrine at 1:200,000 in hemodynamically unstable patients is safer. 12 We used 1:80,000 concentration of epinephrine and found it to be successful; the same study can be done with different doses of epinephrine and the procedure can be drawn to much safer doses. We observed no significant cardiovascular disturbance in any of the patients.…”