Chondrotoxic effects of intra-articular injection of local anaesthetics in the rabbit temporomandibular joint.

The aim of this study was to investigate the chondrotoxic effects of a single-dose intra-articular injection of articaine, lidocaine, and bupivacaine on the rabbit temporomandibular joint (TMJ). Twenty-four rabbits were divided into four groups: control (group 1), articaine (group 2), lidocaine (group 3), and bupivacaine (group 4). Synovial fluid samples and venous blood were taken to evaluate matrix metalloproteinase 3 (MMP-3) levels. One millilitre of local anaesthetic solution was injected in the study groups and saline solution in the control group. The rabbits were euthanized after 4 weeks and the mandibular condyles and articular discs were evaluated. On histological examination, the study group samples had irregular joint surfaces, decreased collagen, and a thinner cartilage layer. Apoptotic cells were evaluated with the TUNEL method. TUNEL-positive apoptotic cell counts were higher in all study groups compared to the control group, and the difference was significant (P < 0.001). The mean preoperative serum MMP-3 level for all groups was 5.71 ± 3.33 ng/mL, while the mean postoperative level was 22.61 ± 6.36 ng/mL; this difference was significant (P < 0.001). A single-dose intra-articular injection of local anaesthetic had apoptotic effects on chondrocytes, leading to degenerative changes in the TMJ articular structures. Articaine was found to have less harmful effects than lidocaine and bupivacaine. Intra-articular injection of local anaesthetics should be limited in the TMJ because of the potential toxic effects.

Physicochemical characterization and cytotoxicity of articaine-2-hydroxypropyl-ß-cyclodextrin inclusion complex.

Articaine (ATC) is one of the most widely used local anesthetics in dentistry. Despite its safety, local toxicity has been reported. This study aimed to develop an ATC-2- hydroxypropyl-ß-cyclodextrin inclusion complex (ATC HPßCD) and to assess its toxicity in vitro. The inclusion complex was performed by solubilization, followed by a fluorimetric and job plot assay to determine the complex stoichiometry. Scanning electron microscopy, DOSY- 1 H-NMR, differential scanning calorimetry (DSC), and sustained release kinetics were used to confirm the inclusion complex formation. In vitro cytotoxicity was analyzed by MTT assay and immunofluorescence in HGF cells. Fluorimetric and job plot assay determined the inclusion complex stoichiometry (ATC:HPßCD = 1:1) and complex formation time (400 min), as indicated by a strong host/guest interaction (Ka = 117.8 M - 1), complexed fraction (f = 41.4%), and different ATC and ATC HPßCD melting points (172 °C e 235 °C, respectively). The mean of cell viability was 31.87% and 63.17% for 20-mM ATC and 20-mM ATC HPßCD, respectively. Moreover, remarkable cell toxicity was observed with free ATC by immunofluorescence. These results indicate the ATC HPßCD complex could be used to improve the safety of ATC. Further research are needed to establish the anesthetic safety and effectiveness in vivo .

Effects of Lidocaine and Articaine on Neuronal Survival and Recovery.

The local anesthetics lidocaine and articaine are among the most widely used drugs in the dentist's arsenal, relieving pain by blocking voltage-dependent Na+ channels and thus preventing transmission of the pain signal. Given reports of infrequent but prolonged paresthesias with 4% articaine, we compared its neurotoxicity and functional impairment by screening cultured neural SH-SY5Y cells with formulations used in patients (2% lidocaine + 1:100,000 epinephrine or 4% articaine + 1:100,000 epinephrine) and with pure formulations of the drugs. Voltage-dependent sodium channels Na(v)1.2 and Na(v)1.7 were expressed in SH-SY5Y cells. To test the effects on viability, cells were exposed to drugs for 5 minutes, and after washing, cells were treated with the ratiometric Live/Dead assay. Articaine had no effect on the survival of SH-SY5Y cells, while lidocaine produced a significant reduction only when used as pure powder. To determine reversibility of blockage, wells were exposed to drugs for 5 minutes and returned for medium for 30 minutes, and the calcium elevation induced by depolarizing cells with a high-potassium solution was measured using the calcium indicator Fura-2. High potassium raised calcium in control SH-SY5Y cells and those treated with articaine, but lidocaine treatment significantly reduced the response. In conclusion, articaine does not damage neural cells more than lidocaine in this in vitro model. While this does not question the safety of lidocaine used clinically, it does suggest that articaine is no more neurotoxic, at least in the in vitro setting.

Effect of articaine on mental nerve anterior portion: histological analysis in rats.

OBJECTIVES: The aim of this study was to evaluate the possible toxic effects of articaine and lidocaine on mental nerve, due to the increasing number of paresthesia cases after nerve blocks. MATERIALS AND METHODS: The drugs were injected in the anterior portion of mental nerve of 24 rats, divided into three groups: G1--4% articaine with 1:100,000 epinephrine; G2--2% lidocaine with 1:100,000 epinephrine and G3--plain 1:100,000 epinephrine solution. These solutions were injected in the right side of the rat's mandible and the left side was used as control (0.9% saline solution). Previously to the injections, the animals were anesthetized with thiopental and, 24 h after the injections, their jaws were removed and submitted to routine histological techniques. A histopathological analysis was performed by optical microscopy. RESULTS: An inflammatory infiltration was found around mental nerve, classified as intense for G3, moderate for G1 and light for both G2 and control groups. No injuries were found in nervous structure, despite the inflammatory reaction observed around it. CONCLUSION: The results suggest that articaine is not toxic to the nervous structure and further studies are necessary to explain the possible relation between articaine injection and paresthesia.

Effect of PaCO2 and PaO2 on lidocaine and articaine toxicity.

Alterations in arterial PaCO2 can influence local anesthetic toxicity. The objective of this study was to evaluate the effect of stress-induced changes in PaCO2 and PaO2 on the seizure threshold of lidocaine and articaine. Lidocaine (2% with 1 : 100,000 epinephrine) or articaine (4% with 1 : 100,000 epinephrine) was administered intravenously under rest or stress conditions to 36 rats separated into 4 groups. Propranolol and prazosin were administered preoperatively to minimize cardiovascular effects of epinephrine. Mean arterial pressure (MAP), heart rate (HR), and arterial pH, PaCO2, and PaO2 were measured. Results showed no differences in MAP, HR, or pH. Stress significantly increased the latency period for the first tonic-clonic seizure induced by a toxic dose of both lidocaine and articaine (P < .05). Seizures were brought on more rapidly by articaine. No significant difference between toxic doses of lidocaine and articaine was noted. Stress raised the seizure threshold dose for both drugs and significantly (P < .01) increased arterial PaO2 from 94.0 ± 1.90 mm Hg to 113.0 ± 2.20 mm Hg, and reduced PaCO2 from 36.0 ± 0.77 mm Hg to 27.0 ± 0.98 mm Hg. In conclusion, reduction in PaCO2 and/or increase in PaO2 raised the seizure threshold of lidocaine and articaine. This study also confirmed that lidocaine and articaine have equipotent central nervous system toxicity.

Assessment of genotoxicity of Lidocaine, Prilonest and Septanest in the Drosophila wing-spot test.

The scope of this study was to characterize the likely interaction Lidocaine, Prilonest and Septanest have with DNA, with a view to quantitatively and qualitatively establishing mutagenic, clastogenic, and/or recombinagenic activity of those compounds. The wing somatic mutation and recombination test in Drosophila melanogaster, which detects simultaneously point and chromosomal mutations as well as recombination induced by the activity of genotoxins of direct and indirect action, was used. Each of the anesthetics was tested at different concentrations, administered orally for 48 h to 3rd-stage larvae, in two independent experiments, with concurrent negative controls. The results obtained revealed that only Prilonest exhibits genotoxic activity in somatic cells, being able to induce exclusively homologous recombination. Additionally, it was possible to conclude that the genotoxic effect attributed to Prilonest is not related to metabolites produced via the P450-type enzymes. However, both Lidocaine and Septanest are unable to induce either events related to gene and chromosomal mutation, or reciprocal recombination.

Studies on the toxicological profile of the local anaesthetic articaine.

The toxicity of articaine (CAS 23964-58-1) and of a respective preparation (Septanest SP; 4% articaine HCl and epinephrine 1: 100,000) was examined in in vitro and in vivo experiments. The following endpoints were examined: repeated dose toxicity, reproduction toxicity, mutagenic potential and local tolerance. Repeated s.c. administration of articaine HCl in rats and dogs demonstrated no pathomorphological systemic changes even at systemically toxic doses. The no-effect level (NOEL) was 25 mg articaine HCl/kg b.w./day s.c. for the rat and 40 mg articaine HCl/kg b.w./day s.c. for the dog. Reproduction studies were performed in rats and rabbits at doses up to more than 10 times the maximum recommended human dose of 7 mg articaine HCl/kg b.w. and revealed no evidence of harm to the foetus or to other aspects of reproduction, even at doses toxic to the parental animals. Four standard in vitro and in vivo mutagenicity studies have shown no mutagenic potential up to cytotoxic concentrations or up to the maximum tolerated dose level. The local tolerance of articaine HCl was good to very good. The preclinical data indicate that articaine HCl does not possess any relevant side-effects or gross toxicity and can be considered a safe local anaesthetic.

[Morphological changes of peripheral nerves following intraneural injection of local anesthetic]. / Morphologische Veränderungen peripherer Nerven nach intraneuraler Lokalanästhesieinjektion.

Neurosensory disturbances of the third branch of the trigeminal nerve occur in rare cases without any operative treatment near the nerve involved. The most frequently affected nerve branches are the inferior alveolar nerve and the lingual nerve. We examined the problem of intraneural injection of local-anaesthetic solutions in an experimental study on animals. After intraneural injection of Articain (4%)-solution in the ischiadic nerve of Wistar rats and the lingual nerve of cats no toxic lesions were observed. It can be assumed that neurosensory disturbances caused by intraneural local-anaesthetic injection are the result of intraneural haematomas with consecutive fibrosis.