Locoregional anesthesia for dental treatment in cardiac patients: a comparative study of 2 percent plain lidocaine and 2 percent lidocaine with epinephrine (1:100, 000)

OBJECTIVES: This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine. METHODS: This randomized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brazil). Patients were separated into two groups with the help of an aleatory number table: 2 percent plain lidocaine (PL, n= 31) and 2 percent lidocaine with epinephrine (1:100,000) (LE, n= 28). Blood pressure, heart rate, oxygenation and electrocardiogram data were all recorded throughout the procedure. State and trait anxiety levels were measured. RESULTS: Fifty-nine patients were selected for the LE group (n=28), with an average age of 40.3 ± 10.9, or for the PL group (n=31), age 42.2 ± 10.3. No differences were shown in blood pressure, heart rate and pulse oximetry values before, during and after local anesthesia injection between the two groups. State and trait anxiety levels were not different. Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment. Complaints of pain during the dental procedure were more frequent within the PL group, which received a higher amount of local anesthesia. CONCLUSION: Lidocaine with epinephrine (1:100,000) provided effective local anesthesia. This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases.

Anestesia loco-regional para tratamento odontológico em pacientes cardiopatas: estudo comparativo entre lidocaína 2 por cento sem adrenalina e lidocaína 2 por cento com adrenalina 1:100.000 / Lo-regional anesthesia for cardiac patients odontologic treatment: comparative study between plain 2 per cent and lidocaína 2 per cent with epinephrine

Este estudo prospectivo, randomizado, duplo-cego investigou alterações hemodinâmicas em pacientes valvopatas durante tratamento odontológico com aplicação de lidocaína 2 por cento sem adrenalina (n= 31, idade 42.2  10.3) e lidocaína 2 por cento com adrenalina 1:100.000 (n= 28, idade 40.3  10.9). A análise do registro dos valores da pressão arterial sistêmica, freqüência cardíaca, saturação de oxigênio e traçado eletrocardiográfico, durante e após a aplicação do anestésico, não mostrou diferença estatística entre os dois grupos (P > 0,05). Arritmias observadas previamente ao tratamento odontológico não foram agravadas após a anestesia. Conclusão: a lidocaína 2 por cento com adrenalina 1:100.000 mostrou eficácia anestésica superior sem causar alterações hemodinâmicas em valvopatas / This prospective, randomized double-blinded study investigated hemodynamic changes in valvular cardiac patients during dental treatment with the use of a local anesthesia containing epinephrine. There were two groups: PL (plain 2 per cent lidocaine, n= 31, age 42.2  10.3) and LE (2 per cent lidocaine with 1:100.000 epinephrine, n= 28, age 40.3  10.9). A DIXTAL monitor, used to capture blood pressure, heart rate, oxygenation and eletrocardiogram records, during and after local anesthesia injection, did not show any difference between the two groups (P > 0,05). Arrhythmias observed prior to dental anesthesia did not suffer alterations of shape or gravity after it. Conclusion: 2 per cent lidocaine with epinephrine 1:100.000 showed a superior anesthetic efficiency without leading to hemodynamics changes...