Efficacy of phentolamine mesylate in reducing the duration of various local anesthetics

Abstract

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).

Use of Phentolamine Mesylate in Implant Surgery: Analysis of Adverse Effects and Haemodynamic Changes

“…These authors also reported dentist satisfaction, which was 86 and 82%, respectively, and stated that PM met a patient need in their clinics and fulfilled its expectations. These results are similar to those of the present study, as patients also reported a high degree of satisfaction with the use of PM, although somewhat less compared to the results of Gago et al [29], with 98.9% of patients reporting that they would recommend PM.…”

“…In a recent randomised double-blind clinical trial using three local anaesthetics (lidocaine, articaine and bupivacaine) associated with a vasoconstrictor published by Gago et al [29], it was found that lip and tongue sensation recovery time was slightly higher than that observed in this present study: 88.5 min for the lip and 84.5 min for the tongue. As there was no control group, their results were extrapolated from the duration times described by the manufacturers and reported in the literature.…”

Use of Phentolamine Mesylate in Implant Surgery. Analysis of Adverse Effects and Haemodynamic Changes

“…In turn, these authors reported dentists' satisfaction, where 86 and 82%, respectively, stated that PM met a need in patients in their clinics and that it fulfilled the expectations of the product. These results coincide with those of the present study, where patients also reported a high degree of satisfaction with the use of PM, although they are somewhat lower than the results of Gago et al [29], where 98.9% of patients reported that they would recommend PM.…”

“…In a recent study published by Gago et al [29], using three local anaesthetics: lidocaine, articaine and bupivacaine, associated with a vasonconstrictor, in a randomised double-blind clinical trial, it was found that lip and tongue sensation recovery time was slightly higher than that observed in our study; 88.5 minutes for the lip and 84.5 minutes for the tongue. As there was no control group, their results were extrapolated from the duration times described by the manufacturers and reported in the literature.…”

Sodium Channels and Local Anesthetics—Old Friends With New Perspectives

“…One option to support ending the effect of LAs is to accelerate the dissociation from the Nav by increased blood flow in the surrounding area by the use of vasodilators such as the α-receptor antagonist phentolamine. This drug has approval in dental interventions for reversal of LA effects when used in combination with vasoconstrictors ( Gago-García et al, 2021 ).…”