RESUMEN
OBJECTIVE: To compare the efficacy and safety of inferior alveolar nerve blocks (IANB) with additional buccal infiltration (standard technique) and of buccal and lingual anaesthetic infiltration (experimental technique) for lower third molar (L3M) extractions. STUDY DESIGN: A randomised, double-blind clinical trial involving 129 L3M extractions was conducted. In the IANB group, an IANB was performed using the conventional approach, followed by a buccal injection in the extraction area. In the infiltration group (INF), an infiltration was performed in the buccal and lingual areas of the lower second molar. A 4% articaine solution was employed in all cases. The main outcome variable was anaesthetic efficacy. Other variables like intraoperative and postoperative pain, onset time and adverse events were also recorded. Descriptive and bivariate analyses of the data were made. RESULTS: 120 patients were randomised. The IANB group showed significantly higher anaesthetic efficacy than the INF group (64.4 vs. 45.8%) (odds ratio = 0.47; 95% confidence interval = 0.22-0.97; p = 0.042). No complications were observed. CONCLUSIONS: IANB with additional buccal infiltration is more suitable than the experimental technique for achieving adequate analgesia in L3M extractions. Moreover, the standard method is safe and provides a shorter onset time and lower initial postoperative pain levels.
Asunto(s)
Anestesia Dental , Bloqueo Nervioso , Anestesia Local , Anestésicos Locales , Carticaína/efectos adversos , Método Doble Ciego , Humanos , Lidocaína , Nervio Mandibular , Tercer Molar/cirugía , Bloqueo Nervioso/efectos adversosRESUMEN
Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.
Asunto(s)
Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Diplopía/etiología , Epinefrina/efectos adversos , Oftalmoplejía/etiología , Extracción Dental , Adulto , Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Epinefrina/administración & dosificación , HumanosRESUMEN
The biochemical composition of articaine differs from other amide anaesthetics. The lipophilic part of articaine consists of a thiophene ring, whereas other amide anaesthetics contain a benzene ring. When used correctly, local anaesthetics are remarkably safe. However, all local anaesthetics are potentially neurotoxic. In rare cases a prolonged abnormal perception/sensation may be present after the expected duration of action (paraesthesia). In several countries retrospective studies have been conducted that examined the incidence of persistent paraesthesia after the use of local anaesthetics. In most studies the number of paraesthesia cases after the use of articaine was higher than the market share of this anaesthetic. In animal studies and in cell culture experiments, however, articaine did not have a higher toxicity compared to other amide anaesthetics. Further studies of the cause of paraesthesia after administration of local anaesthetics seem to be warranted.
Asunto(s)
Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Anestesia Local , Animales , HumanosRESUMEN
In patients undergoing endoscopic transsphenoidal hypophysectomy, the nasal mucosa is often infiltrated with local anesthetic solutions that contain epinephrine to aid hemostasis. This may, however, result in hemodynamic changes, especially hypotension. We characterized the cardiovascular changes using a LiDCOrapid monitor in 13 patients after the infiltration of 4% articaine containing 1:200,000 epinephrine. Nine (69%) had a >20% decrease in mean arterial pressure at a median time of 116 seconds after the infiltration of articaine with epinephrine. Analysis of the cardiac output data revealed that this was caused by a sustained reduction in systemic vascular resistance. The arterial blood pressure normalized over a period of 60 to 90 seconds secondary to increases in stroke volume and heart rate producing an elevation in cardiac output. Transient hypotension following the infiltration of epinephrine-containing local anesthetics may be caused by epinephrine stimulation of ß2-adrenoceptors producing vasodilation.
Asunto(s)
Anestesia Local/efectos adversos , Epinefrina/efectos adversos , Hipofisectomía/métodos , Hipotensión/inducido químicamente , Hipotensión/fisiopatología , Cavidad Nasal/cirugía , Vasoconstrictores/efectos adversos , Adulto , Anciano , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Presión Sanguínea/efectos de los fármacos , Carticaína/administración & dosificación , Carticaína/efectos adversos , Epinefrina/administración & dosificación , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipofisectomía/efectos adversos , Masculino , Persona de Mediana Edad , Mucosa Nasal , Estudios Prospectivos , Volumen Sistólico/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Vasoconstrictores/administración & dosificaciónRESUMEN
In recent times there has been raised interest regarding the use of articaine hydrochloride as a dental local anaesthetic solution. The use of articaine hydrochloride as a dental local anaesthetic agent has been reported to be safe and effective. Paraesthesia is a rare but unwanted adverse effect attributed to the use of this local anaesthetic in dentistry, particularly following the administration of a nerve block injection. There is no evidence to support the opinion that the use of articaine carries a greater associated risk of paraesthesia than with the use of any other local anaesthetic. Clinical Relevance: The aim of this article is to review the relative merits of articaine hydrochloride against its documented potential drawbacks. The article will also aim to update readers on the use of articaine hydrochloride for local analgesia in dentistry, including the pharmacology, efficacy and safety concerns (including the risks of nerve paraesthesia) commonly associated with the administration of this agent.
Asunto(s)
Anestesia Dental/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Anestesia Local/métodos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Humanos , Nervio Mandibular/efectos de los fármacos , Parestesia/inducido químicamente , SeguridadRESUMEN
This study was aimed to evaluate the possible alert signals of paraesthesia by local anaesthetics, focusing on those used in dentistry. A case/non-case study of spontaneous adverse events recorded in FAERS (FDA Adverse Event Reporting System) between 2004 and 2011 was performed. Cases were represented by the reports of reactions grouped under the term 'Paraesthesias and dysaesthesias' involving local anaesthetics (ATC: N01B*); non-cases were all other reports of the same drugs. Reporting odds ratios (ROR) with the relevant 95% confidence intervals (95CI) were calculated. Alert signal was considered when number of cases >3 and lower limit of ROR 95CI > 1. To estimate the specificity of signals for dentistry, the analysis was restricted to the specific term "Oral Paraesthesia" and to reports concerning dental practice. Overall, 528 reports of 'Paraesthesias and dysaesthesias' were retrieved, corresponding to 573 drug-reaction pairs (247 lidocaine, 99 bupivacaine, 85 articaine, 30 prilocaine, 112 others). The signal was significant only for articaine (ROR=18.38; 95CI = 13.95-24.21) and prilocaine (2.66; 1.82-3.90). The analysis of the specific term "Oral Paraesthesia" retrieved 82 reports corresponding to 90 drug-reaction pairs (37 articaine, 19 lidocaine, 14 prilocaine, 7 bupivacaine, 13 others) and confirmed the signal for articaine (58.77; 37.82-91.31) and prilocaine (8.73; 4.89-15.57). The analysis of reports concerning dental procedures retrieved a signal for articaine, both for any procedures (8.84; 2.79-27.97) and for non-surgical ones (15.79; 1.87-133.46). In conclusion, among local anaesthetics, only articaine and prilocaine generated a signal of paraesthesia, especially when used in dentistry.
Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos , Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Parestesia/inducido químicamente , Prilocaína/efectos adversos , United States Food and Drug Administration , Minería de Datos , Bases de Datos Factuales , Humanos , Parestesia/diagnóstico , Seguridad del Paciente , Medición de Riesgo , Estados UnidosRESUMEN
The study evaluated the effect of local anesthesia with articaine in different combinations with epinephrine and clonidine (articaine (4%) + epinephrine (1:200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1:400 000) + clonidine (1:100 000)), on a number of physiological parameters in pediatric dental practice that characterize cardiovascular system, patient's degree of adaptation to a stressful situation and efficacy of analgesia. It is shown that in terms of impact on the cardiovascular system and stress adaptation indicators anesthesia including combination of epinephrine (1: 200 000) and clonidine (1: 100 000) in the anesthetic solution is the safest. Furthermore, this method ensures the most appropriate analgesic effect.
Asunto(s)
Adaptación Fisiológica/efectos de los fármacos , Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Sistema Cardiovascular/efectos de los fármacos , Carticaína/efectos adversos , Clonidina/efectos adversos , Epinefrina/efectos adversos , Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Carticaína/administración & dosificación , Niño , Clonidina/administración & dosificación , Epinefrina/administración & dosificación , Femenino , Humanos , MasculinoRESUMEN
The rationale for the choice of local anesthesia in teeth with mild to moderate periodontal disease was formulated based on a comparative analysis of the effectiveness and safety of different local anesthesia methods with 4% articaine. Effectiveness of anesthesia was assessed using objective values of electric study of pulp sensitivity and registration of microcirculation in dental pulp. Safety analysis was based on changes in periodontal tissues microcirculation assessed by laser Doppler flowmetry, as well as of central hemodynamics rates.
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Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Epinefrina/efectos adversos , Enfermedades Periodontales/terapia , Adulto , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Pulpa Dental/irrigación sanguínea , Pulpa Dental/patología , Epinefrina/administración & dosificación , Femenino , Humanos , Flujometría por Láser-Doppler , Masculino , Microcirculación , Persona de Mediana Edad , Seguridad , Adulto JovenRESUMEN
Many intraoperative complications occurring during third molar surgery are described in the literature. Unilateral trochlear nerve palsy secondary to dental anaesthesia is a rare complication. We report the case of a 36-year-old healthy man, ASA I classification, requiring upper third molar extraction. Articaine 1:200,000 epinephrine for right posterior superior alveolar (PSA) nerve block was administered locally in the mucobuccal fold above the upper third molar. A few minutes after PSA nerve block the patient experienced double-vision. The patient was subsequently visited by an ophthalmologist and the condition was diagnosed as transient unilateral vertical diplopia due to temporary paralysis of the superior oblique muscle as a result of the anaesthetic solution involving the IV cranial nerve. The authors report this unusual case and discuss the possible anatomical pathways that might explain this rare phenomenon.
Asunto(s)
Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Carticaína/administración & dosificación , Diplopía/etiología , Tercer Molar/cirugía , Bloqueo Nervioso/efectos adversos , Enfermedades del Nervio Troclear/etiología , Adulto , Carticaína/efectos adversos , Humanos , Masculino , Nervio Maxilar , Músculos Oculomotores/patologíaRESUMEN
The aim of the work was to improve the technique of local anesthesia with "ultrakain D-S" in surgical operations in urology. The research included 50 patients with penis diseases, 70 patients with diseases of the scrotum body, 40 patients with various prostate diseases complicated by acute urinary retention. Operative interventions in the patients were carried out with "ultrakain D-S". The control group consisted of patients with similar pathology and operations under local anesthesia, but with lidocain as anesthesia. The data obtained show that in more pronounced anesthetizing effect of "ultrakain D-S" the quantity of the injected drug was less as well as the time necessary for getting anesthesia was shorter than in the control group.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Enfermedades Urológicas/cirugía , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Humanos , Masculino , Dimensión del Dolor , Enfermedades Urológicas/fisiopatologíaRESUMEN
PURPOSE: To compare the pain induced by tissue infiltration of lidocaine 2% with epinephrine 1:100,000 versus articaine 4% with epinephrine 1:100,000 for eyelid surgery. METHODS: Thirty patients undergoing bilateral eyelid surgery were enrolled in a prospective, randomized, double-masked study. Each subject received injections of lidocaine 2% with epinephrine 1:100,000 (Xylocaine) on one side and articaine 4% with epinephrine 1:100,000 (Septocaine) on the other for surgical anesthesia. The patients rated the pain of infiltration using a 100-mm visual analogue scale immediately after receiving each injection. The pain scores were compared using the paired t test. RESULTS: Twenty-two of the 30 patients (73.3%) rated the articaine injection as less painful than the lidocaine injection. The mean pain score for lidocaine was 42.60 +/- 24.74 and the pain score for articaine was 31.85 +/- 20.28 (p = 0.011). CONCLUSIONS: In this study, infiltration of articaine was less painful than lidocaine for eyelid surgery, making articaine an attractive alternative for local anesthesia.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Epinefrina/efectos adversos , Enfermedades de los Párpados/cirugía , Lidocaína/efectos adversos , Dolor/inducido químicamente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/administración & dosificación , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: Both prilocaine and articaine are short-acting local anaesthetics suited for spinal anaesthesia for day-case knee arthroscopy. Articaine is thought to have a faster onset and shorter duration of action than prilocaine, although no comparative study has been published in the anaesthetic literature. METHODS: In this prospective randomized double-blind study, spinal anaesthesia was performed in 72 ASA I-II patients undergoing knee arthroscopy with 50 mg of either plain prilocaine or plain articaine. The primary outcome variable was duration of motor block. Secondary outcomes were onset of sensory and motor blocks, maximum spread of the sensory block, time to spontaneous voiding, and side-effects. RESULTS: Time to full motor function recovery was shorter after articaine than prilocaine [mean (SD) 140 (33) vs 184 (46) min, respectively, P<0.001]. Time to spontaneous voiding was shorter after articaine than prilocaine [mean (SD) 184 (39) vs 227 (45) min, respectively, P<0.001]. One patient in the articaine group reported mild transient neurological symptoms (TNS) limited to the first postoperative day, but there were no significant differences in adverse effects between the groups. CONCLUSIONS: Spinal anaesthesia with plain articaine 50 mg resulted in a faster recovery of motor function and earlier spontaneous voiding compared with plain prilocaine 50 mg. Surgical anaesthesia was not different. The incidence of TNS was low.
Asunto(s)
Anestesia Raquidea/métodos , Artroscopía/métodos , Carticaína/administración & dosificación , Articulación de la Rodilla/cirugía , Prilocaína/administración & dosificación , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios/métodos , Periodo de Recuperación de la Anestesia , Anestesia Local/métodos , Anestesia Raquidea/efectos adversos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento/efectos de los fármacos , Prilocaína/efectos adversos , Estudios Prospectivos , Sensación/efectos de los fármacos , Factores de Tiempo , Micción/efectos de los fármacos , Adulto JovenRESUMEN
BACKGROUND: The literature describes different local complications derived from a local anesthetic. The authors present a report of a case of such a complication-a complication of which they have identified only one other similar case in the literature. CASE DESCRIPTION: A 10-year-old girl received an inferior alveolar nerve block injection for a dental restoration on the right side. After the procedure, she developed pallor of the right side of the lower lip and chin that subsequently evolved into a surface ulceration. The lesion suddenly healed 15 days later. The authors ruled out self-inflicted injury, intra-operative injury and skin infection as causes. CONCLUSIONS: and CLINICAL IMPLICATIONS: On the basis of the clinical manifestations and affected anatomical structures, the authors postulated skin necrosis secondary to vascular spasm of the terminal branches of the inferior alveolar artery. Even when clinicians use the utmost care, this kind of complication can occur as a result of an inferior alveolar nerve block injection. The practitioner should diagnose the problem appropriately and reassure the patient.
Asunto(s)
Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Bloqueo Nervioso/efectos adversos , Enfermedades de la Piel/patología , Carticaína/administración & dosificación , Carticaína/efectos adversos , Niño , Mentón , Combinación de Medicamentos , Epinefrina/administración & dosificación , Epinefrina/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Inyecciones/efectos adversos , Mandíbula , Nervio Mandibular , Necrosis/etiología , Enfermedades de la Piel/etiologíaRESUMEN
BACKGROUND/AIMS: [corrected] The aim of this study was to compare the efficacy and safety of 4% articaine with a mixture containing equal volumes of 2% lidocaine and 0.5% levobupivacaine without hyaluronidase for sub-Tenon's anaesthesia in phacoemulsification cataract surgery. METHODS: The study was a prospective, randomised double-masked clinical trial of 65 patients allocated to receive either 4% articaine or a mixture containing equal parts of 2% lidocaine and 0.5% levobupivacaine. All patients had pre- and postoperative Hess charting to document ocular motility dysfunction. Ocular and eyelid movements were scored at 2 min intervals from 2 to 10 min after injection of the anaesthetic agent, and at the end of surgery. Complications related to injection, including pain, chemosis and subconjunctival haemorrhage, were recorded. Patients rated pain (none/mild/moderate/severe) during surgery. The operating surgeon masked to the anaesthetic agent assessed proptosis/chemosis at the start of the operation and the degree of ocular akinesia and analgesia at the end of surgery. RESULTS: The articaine group demonstrated a rapid onset of ocular akinesia with a mean time to readiness for surgery (achieving a score of =5) of 4.0 min compared with 10 min for the lidocaine/levobupivacaine group (p = 0.001). The effectiveness of block was significantly greater in the articaine group at all points (p<0.01). Surgeons rated ocular akinesia to be superior in the articaine group (p<0.001). Patients and surgeons rated the analgesic effect as comparable in either group. Eyelid scores, subconjunctival haemorrhage and chemosis were comparable in either group. Hess chart was performed on all patients pre- and postoperatively. There was no clinically significant motility disturbance in the articaine group, whereas one patient in the lidocaine/levobupivacaine group developed diplopia with abnormal ocular motility on the Hess chart. CONCLUSION: Articaine (4%) is a safer and a superior anaesthetic agent than a mixture of 2% lidocaine and 0.5% levobupicaine in achieving ocular akinesia for sub-Tenon's block in phacoemulsification cataract surgery.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Facoemulsificación , Anciano , Anciano de 80 o más Años , Anestesia Local/efectos adversos , Anestésicos Combinados/administración & dosificación , Anestésicos Combinados/efectos adversos , Anestésicos Locales/efectos adversos , Actitud del Personal de Salud , Bupivacaína/análogos & derivados , Carticaína/efectos adversos , Método Doble Ciego , Movimientos Oculares/efectos de los fármacos , Femenino , Humanos , Levobupivacaína , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/inducido químicamente , Satisfacción del Paciente , Estudios ProspectivosRESUMEN
A 36-year-old female patient developed diplopia and an ipsilateral lateral rectus paresis following local anesthetic administration to remove a left maxillary second molar. Complete resolution occurred within 3 hours. The clinical examination and management plan are reviewed for this uncommon occurrence. The relevant anatomical pathways are discussed and illustrated with photographs.
Asunto(s)
Nervio Abducens/efectos de los fármacos , Anestesia Dental/efectos adversos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Diplopía/inducido químicamente , Nervio Abducens/irrigación sanguínea , Anestesia Local/efectos adversos , Vías Eferentes/fisiología , Femenino , Humanos , Nervio Maxilar/fisiología , Diente Molar/cirugía , Músculos Oculomotores/efectos de los fármacos , Músculos Oculomotores/inervación , Paresia/inducido químicamente , Extracción DentalRESUMEN
Local anesthetics are the safest most effective drugs in medicine for the control and management of pain. They also represent the most important drugs in dentistry. Today, dentistry has a spectrum of local anesthetics that permit pain control to be tailored to the specific needs of the patient: short-, intermediate-, and long-acting drugs. Bupivacaine has become a standard part of the armamentarium for postsurgical pain control while articaine has become the second-most used local anesthetic in the United States since its introduction in 2000. Despite an increase in anecdotal reports of paresthesia since articaine's introduction there is yet, no supporting scientific evidence.
Asunto(s)
Anestesia Dental/métodos , Anestésicos Locales , Anestesia Local/métodos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Humanos , Traumatismos del Nervio Lingual , Parestesia/inducido químicamente , Traumatismos del Nervio Trigémino , Estados UnidosAsunto(s)
Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Síndrome de Kearns-Sayre/inducido químicamente , Síndrome de Kearns-Sayre/patología , Anestésicos Locales/química , Anestésicos Locales/farmacocinética , Carticaína/química , Carticaína/farmacocinética , HumanosRESUMEN
Worsening of the neuromuscular manifestations in Kearns-Sayre syndrome after administering local anesthesia with articaine has not been reported. The authors describe a severe adverse reaction to local anesthesia with articaine for tooth extraction in a 28-year-old woman with Kearns-Sayre syndrome due to a 5.9-kb mitochondrial DNA deletion. The patient was subjected to local anesthesia with 1.5 mL (60 mg) articaine in the left submandibular nerve for tooth extraction. Five minutes after the injection the patient developed weakness of the limb muscles, extreme fatigue with increased desire to sleep, a feeling of heat, inappetence, and frequent urination. The adverse reaction resolved spontaneously within 48 hours without sequelae. Administration of articaine may cause severe side effects in patients with Kearns-Sayre syndrome. Articaine should be used with caution in these patients.