Keywords
lidocaine
local anaesthesia
vitals
Abstract
Introduction: Most of the minor oral surgical procedures are performed under local anaesthesia (LA). Vasoconstrictor present in LA decreases the rapid absorption of LA, decreases systemic toxicity, increases duration of LA and provides local hemostasis which favor clinicians for better work performance. But it is also known to increase heart rate (HR) and blood pressure (BP).
Objective: To evaluate the effect of vasoconstrictor adrenaline 1:80,000 in 1.8 ml of 2% Lidocaine on systolic and diastolic blood pressure, pulse rate and oxygen saturation of normotensive patients.
Methods: A prospective randomized study was conducted on 70 patients who were divided randomly into 2 parallel groups according to the LA received. Group 1 (G1): lidocaine 2% without adrenaline and Group 2 (G2): lidocaine 2% with adrenaline 1:80,000. Blood pressure, pulse rate and oxygen saturation were measured before and 10 minutes after LA administration for each patient.
Results: Statistically significant rise in blood pressure and pulse rate was seen in group receiving LA with adrenaline (G2) 10 minutes after administration.
Conclusion: Though adrenaline amount in 1.8ml causes significant rise of parameters assessed under the study, the rise is not clinically relevant for a normotensive, medically fit patient.
References
Malamed SF, Gagnon S, Leblanc D. A comparison between articaine HCl and lidocaine HCl in pediatric dental patients. Pediatr Dent.2000;22:307-11.
Matsumura K, Miura K, Takata Y, Kurokawa H, Kajiyama M, Abe I, et al. Changes in blood pressure and heart rate variability during dental surgery. Am J Hypertens.1998;11:1376-80.
Porto G, Vasconcelos BC, Gomes AC, Albert D. Evaluation of lidocaine and mepivacaine for inferior third molar surgery. Med Oral Patol Oral Cir Bucal.2007;12:60-4.
Sierra Rebolledo A, Delgado Molina E, BeriniAytís L, Gay Escoda C. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars. Med Oral Patol Oral Cir Bucal.2007;12:139-44.
Folwaczny C, Heldwein W, Obermaier G, Schindlbeck N. Influence of prophylactic local administration of epinephrine on bleeding complications after polypectomy. Endoscopy. 1997;29:31-3.
Fink BR, Aasheim GM, Levy BA. Neural pharmacokinetics of epinephrine. Anesthesiology.1978;48:263-6.
Dunlevy TM, O’Malley TP, Postma GN. Optimal concentration of epinephrine for vasoconstriction in neck surgery. Laryngoscope.1996;106:1412-4.
O’Malley TP, Postma GN, Holtel M, Girod DA. Effect of local epinephrine on cutaneous blood flow in the human neck. Laryngoscope. 1995;105:140-3.
Gupta KK, Attri JP, Singh A, Kaur H, Kaur G. Basic concepts for sample size calculation: Critical step for any clinical trials! Saudi J Anaesth. 2016;10(3):328-31. PMID: 27375390; PMCID: PMC4916819.
National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2004 Aug. Classification of Blood Pressure.
Serrera Figallo MA, Velázquez Cayón RT, Torres Lagares D, Corcuera Flores JR, Machuca Portillo G. Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies. Review of the literature published in the last decade. J Clin Exp Dent. 2012;4(2):e107-e111.
Meechan JG, Cole B, Welbury RR. The influence of two different dental local anaesthetic solutions on the haemodynamic responses of children undergoing restorative dentistry: a randomised, single-blind, split-mouth study. Br Dent J. 2001;190(9):502-504.
Guyton AC. Textbook of Medical Physiology, 7th ed. Philadelphia: W.B. Saunders Co., 1986:690.
Silvestre FJ, Verdú MJ, Sanchis JL, Grau D, Peñarrocha M. Effects of vasoconstrictors in dentistry upon systolic and diastolic arterial pressure. Med Oral.2001;6:57-63.
Faraco FN, Armonia PL, Simone JL. Assessment of cardiovascular parameters during dental procedures under the effect of benzodiazepines: A double blind study. Braz Dent J. 2003;14:215-9.
Meral G, Tasar F, Sayin F, Saysel M, Kir S, Karabulut E. Effects of lidocaine with and without epinephrine on plasma epinephrine and lidocaine concentrations and hemodynamic values during third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. Endod.2005;100:25-30.
Faraco FN, Kawakami PY, Mestnik MJ, Ferrari DS, ShibliJA.Effect of anesthetics containing lidocaine and epinephrine on cardiovascular changes during dental implant surgery. J Oral Implantol.2007;33:84-8.
Ketabi M, Shamami MS, Alaie M, Shamami MS. Influence of local anesthetics with or without epinephrine 1/80000 on blood pressure and heart rate: A randomized double-blind experimental clinical trial. Dent Res J (Isfahan). 2012;9(4):437-40.
James O, Ladeinde AL, Ogunlew MO, Ajuluchukwu JN, Adeyemo WL. Hemodynamic response after injection of local anesthetics with or without adrenaline in adult Nigerian subjects undergoing simple tooth extraction. J Clin Sci. 2015;12:90-5.
Haghighat A, Kaviani N, Panahi R. Hemodynamic Effects of 2% Lidocaine with 1:80000 Epinephrine in Inferior Alveolar Nerve Block. Dent Res J. 2007; 3(1):4-7.
Shakeel A, Christopher P J, Kengasubbiah S, et al. Hemodynamic Changes Associated with Two Different Concentrations of Adrenaline in Lignocaine Solution: A Comparative Analysis. Cureus.2019;11(4):e4434
Malamed SF. Handbook of local anesthesia. St Louis: CV Mosby Company 1980; 23.