Buffered 2% articaine in buccal infiltration of mandibular molars: a randomized triple-blind clinical trial

Abstract This crossover study aimed to compare the anesthetic effects of buffered 2% articaine with 1:200,000 epinephrine with that of non-buffered 4% articaine with 1:200,000 epinephrine. Forty-seven volunteers were administered two doses of anesthesia in the buccal region of the second mandibular molars in two sessions using 1.8 mL of different local anesthetic solutions. The onset time and duration of pulp anesthesia, soft tissue pressure pain threshold, and the score of pain on puncture and burning during injection were evaluated. The operator, volunteers, and statistician were blinded. There were no significant differences in the parameters: onset of soft tissue anesthesia (p = 0.80), duration of soft tissue anesthesia (p = 0.10), onset of pulpal anesthesia in the second (p = 0.28) and first molars (p = 0.45), duration of pulp anesthesia of the second (p = 0.60) and first molars (p = 0.30), pain during puncture (p = 0.82) and injection (p = 0.80). No significant adverse events were observed. Buffered 2% articaine with 1:200,000 epinephrine did not differ from non-buffered 4% articaine with 1:200,000 epinephrine considering anesthetic success, safety, onset, duration of anesthesia, and pain on injection.

Lingual supplementation may not be required after articaine buccal infiltration anesthesia for lower molar extraction: a clinical comparative study / La suplementación lingual opcional después de la anestesia por infiltración bucal con articaína para la extracción de molares inferiores: un estudio clínico comparativo

Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth. Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant. Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.

Objetivo: Investigar la efectividad anestésica de la infiltración bucal (BI) versus la infiltración bucal más lingual (BI+LI) de articaína al 4% para la extracción intraalveolar de molares mandibulares erupcionados. Material y Métodos: Ochenta pacientes fueron incluidos en este estudio clínico prospectivo. Se dividieron aleatoriamente en 1 de 2 grupos iguales: el primer grupo recibió BI de articaína al 4% 1,8 ml y LI de 0,5 ml, mientras que el segundo grupo recibió articaína al 4% 1,8 ml BI más 0,5 ml LI de solución salina normal. Se administró otro BI de articaína de 1,8 ml si la anestesia inicial era inadecuada. Las variables de resultado incluyeron el dolor, que los pacientes calificaron en 3 intervalos mediante una escala analógica visual, y la anestesia lingual y la satisfacción de los pacientes, que se midieron mediante una escala de calificación verbal de 5 puntos. Los análisis de datos utilizados fueron estadística descriptiva, prueba t, prueba χ2 y coeficiente de correlación de Pearson. Se consideró significativo el valor del valor de pinferior a 0,05. Resultados: Hubo 46 mujeres y 34 hombres y la edad media fue de 35,3 años. Todas las variables de resultado fueron comparables entre los dos grupos de estudio (p=0,05). La anestesia fue exitosa en el 78% y 88% de los casos en los grupos (BI) y (BI+LI) respectivamente sin diferencia significativa (p=0,2392). El volumen medio de articaína utilizado fue de 2,5 ml y 2,87 ml respectivamente sin diferencia significativa (p=0,090). Conclusión: La eficacia anestésica de (BI) solo y (BI+LI) de articaína al 4% fue comparable. Cuando se administra en una dosis adecuada, la articaína (BI) sola podría estar justificada para la extracción intraalveolar de molares mandibulares.

Comparison Of Anaesthetic Efficacy Of Articaine And Lidocaine In Nonsurgical Endodontic Treatment Of Permanent Mandibular Molars With Symptomatic Irreversible Pulpitis. A Randomized Clinical Trial.

BACKGROUND: Inferior Alveolar Nerve Block (IANB) with Buccal Infiltration (BI) anaesthesia is required to completely anesthetize the mandibular molars with symptomatic irreversible pulpitis. 4% Articaine and 2% Lidocaine provide local anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Objective of the study was to compare the effect of Articaine and Lidocaine in the combination of Inferior alveolar nerve block with buccal infiltration anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic Irreversible Pulpitis. METHODS: One hundred and sixty participants with Symptomatic Irreversible Pulpitis of permanent mandibular molars were divided randomly in two groups. Group A was given Articaine 4% IANB along with BI whereas group B was given Lidocaine 2%. Pain was assessed after 15 minutes of administration of local anaesthesia. Anaesthetic success of the agents is defined as, absence of pain or mild pain first during the access cavity preparation then instrumentation of the canals of tooth. Chi-square test was applied to analyse data for statistical significance. RESULTS: Anaesthetic success of Articaine was 96.2% during access cavity preparation compared to Lidocaine (86.2%). Success during instrumentation of canals was also found to be high in Articaine (90.2%) compared to Lidocaine (76.2%). This difference of anaesthetic efficacy between Articaine and Lidocaine was found statistically significant. (p=0.02). CONCLUSIONS: Articaine is found to be better than Lidocaine regarding anaesthetic efficacy and hence, it can be a safer alternative to Lidocaine.

Use of bufferized dental anesthetics in dental surgery / Uso de anestésicos dentários bufferizados em cirurgia dentária / Uso de anestésicos dentales buferizados en cirugía oral

Abstract Introduction and objective: The addition of epinephrine to the anesthetic solution reduces the pH of the solution to a range between 2.9 and 4.4. The acidity of the anesthetic may delay onset and contribute to injection pain. Objective: to determine the intensity of pain during a mandibular third molar surgery after using buffered 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration. Materials and methods: an observational and descriptive clinical study was performed. The buffered solution was alkalinized with 8.4% sodium bicarbonate with a ratio of 9:1, using a hand-mixing methodology, the sample were patients who required a mandibular third molar surgery. After standardizing the anesthetic technique, it was used the inferior alveolar nerve block followed by buccal infiltration. Results: 32 patients (20 female - 62.5% and 12 male - 37.5%), with an average age of 21.12 years (mean ± standard deviation : 21.12 ± 3.61) were admitted to the study. When assessing the pain puncture and during the injection, 94% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 62%. Only a small percentage of patients required complementary anes thesia. Conclusion: buffered 4% of articaine with epinephrine in the in ferior alveolar nerve block with buccal infiltration significantly decreased onset time, injection pain and need for complementary anesthesia in third molar surgery.

Resumo Introdução e objetivo: A adição de adrenalina à solução anestésica reduz o pH da solução para uma faixa entre 2,9 e 4,4. A acidez do anestésico pode atrasar o início e contribuir para a dor da injeção. Determinar a inten sidade da dor durante uma cirurgia dos terceiros molares inferiores após o uso de articaína tamponada a 4% com adrenalina 1: 100000 no bloqueio do nervo alveolar inferior com infiltração bucal. Materiais e métodos: foi realizado um estudo clínico observacional e descritivo. A solução tamponada foi al calinizada com bicarbonato de sódio a 8,4% com uma proporção de 9: 1, utilizando uma metodologia de mistura manual; a amostra era de pacientes que necessitaram de uma cirurgia de terceiros molares inferiores. Após padronização da técnica anes tésica foi utilizada bloqueio do nervo alveolar inferior seguido de infiltração bucal. Resultados: 32 pacientes (20 mulheres - 62,5% e 12 homens - 37,5%), com idade média de 21,12 anos (média ± desvio padrão : 21,12 ± 3,61) foram admitidos no estudo. Ao avaliar a punção dolorosa e durante a injeção, 94% dos pacientes a classificaram como dor leve de acordo com a EVA. Ao avaliar o período de latência, o tempo médio foi inferior a dois minutos e a anestesia perioral dos tecidos moles foi de 62%. Apenas uma pequena porcentagem de pacientes necessitou de anestesia complementar. Conclusão: tamponar 4% de articaína com epinefrina no bloqueio do nervo alveolar inferior com infiltração bucal diminuiu significativamente o tempo de início, a dor da injeção e a necessidade de anestesia complementar em cirurgia de terceiros molares.

Resumen Introducción y objetivo: la adición de epinefrina a la solución anestésica reduce el pH en un rango entre 2.9 y 4.4. La acidez del anestésico puede retrasar el inicio del efecto anestésico y contribuir al dolor durante la inyección de la solución. deter minar la intensidad del dolor durante la cirugía de terceros molares mandibulares después de usar articaína al 4% con epinefrina 1:100000 buferizada, en el bloqueo del nervio alveolar inferior con infiltración bucal. Materiales y métodos: se realizó un estudio clínico observacional y descriptivo. La solución buferizada se alcalinizó con bicarbonato de sodio al 8,4% en una relación de 9:1, utilizando una técnica de mezcla manual, la muestra se obtuvo de pacientes que requerían cirugía del tercer molar mandibular. Después de estandarizar la técnica anestésica fue utilizado un bloqueo del nervio alveolar inferior seguido de una infiltración bucal. Resultados: 32 pacientes (20 mujeres - 62,5% y 12 hombres - 37,5%), con una edad promedio de 21.12 años (media ± desviación estándar : 21.12 ± 3.61) ingresaron al es tudio. Al evaluar el dolor durante la punción y durante la inyección de la solución anestésica, el 94% de los pacientes lo clasificaron como dolor leve según la EVA. Al evaluar el período de latencia, el tiempo promedio fue inferior a dos minutos y la anestesia perioral de tejidos blandos fue del 62%. Solo un pequeño porcentaje de pacientes requirió anestesia complementaria. Conclusión: El uso de 4% de articaína con epinefrina buferizada, en el bloqueo del nervio alveolar inferior con infiltración bucal disminuyó significativamente el tiempo de inicio, el dolor durante la inyección y la necesidad de anestesia complementaria en la cirugía de terceros molares.

Does articaine, rather than prilocaine, increase the success rate of anaesthesia for extraction of maxillary teeth.

OBJECTIVE: To compare the anesthetic performances of 3% prilocaine and 4% articaine when used for the extraction of the maxillary teeth. MATERIALS AND METHODS: Ninety-five patients, aged between 16 and 70 years, were included in this study. Patients were divided into two groups. Group one received articaine 4% with 1:00.000 adrenaline. Group two received prilocaine with 3% felypressin (0.03 I.U. per ml). Onset time of anesthesia was objectively evaluated by using electronic pulp testing. RESULTS: Eighty-five patients in this study had a successful local anesthetic followed by extraction within the study duration time (10 minutes). However, there were six patients with failure anesthesia (5 in prilocaine group and 1 in articaine group). By applying Person's Chi-square test (x2), there were no significant differences in the number of episodes of the anesthetic success between articaine and prilocaine groups at time intervals (P = 0.5). T-test showed that there have been no important variations within the mean onset time of anesthesia for articaine and prilocaine buccal infiltrations (P = 0.1). CONCLUSIONS: 3% Prilocaine with felypressin is as effective as 4% articaine with adrenaline when used for the extraction of maxillary teeth. Recommendations would be given to the dental practitioners to use prilocaine more frequently than articaine because of its low toxicity. TRIAL REGISTRATION NUMBER: NCT04236115.

Observational study of adverse reactions related to articaine and lidocaine.

PURPOSE: This study determined the frequency of adverse reactions related to the administration of local dental anesthesia with 4% articaine compared with 2% lidocaine, both associated with epinephrine 1:100,000. The null hypothesis was that there is no difference between the administrations of both dental local anesthesia. METHODS: From a total of 727 patients in an emergency service, 338 and 389 patients were subjected to local anesthesia with lidocaine and articaine, respectively. A questionnaire was completed for each patient that contained patient data, the local anesthesia applied, and any reactions. RESULTS: The overall frequency of adverse reactions was 3.71%, with sweating and pallor being the most frequently observed. There was an association between adverse reactions and the use of daily medication by patients anesthetized with articaine (p = 0.0266). In contrast, in patients anesthetized with lidocaine, there was an association among the duration of the procedure (p = 0.0423), the type of procedure (p = 0.0146), and first anesthesia exposure (p = 0.0448). CONCLUSIONS: The low frequency of adverse reactions with use of articaine and lidocaine led to the conclusion that both solutions are safe for use in dentistry.

Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial.

It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars. They were randomly divided into two groups and given infiltration anaesthesia with either 4% articaine or 2% lidocaine by a single injection deep into the mucobuccal fold at the site of the tooth. After five minutes the mesial, distal, buccal, and lingual sides of the tooth were probed. Pain at this time or later during dissection of soft tissue by periosteal elevator was considered as failure, and an inferior alveolar nerve block was given. The amount of pain, and the number of patients who developed pain, were significantly greater in the group given 2% lidocaine (p<0.001). The two groups did not differ significantly in age or sex. Articaine is more successful in providing adequate depth of anaesthesia, but its efficacy was not sufficient to replace an inferior alveolar nerve block for extraction of mandibular molars (Registration code: IRCT2016062627111N2).

Does Articaine Provide an Advantage over Lidocaine in Patients with Symptomatic Irreversible Pulpitis? A Systematic Review and Meta-analysis.

INTRODUCTION: Achieving profound pulpal anesthesia can be difficult in patients with symptomatic irreversible pulpitis. This study provides a systematic review and meta-analysis to address the population, intervention, comparison, outcome (PICO) question: in adults with symptomatic irreversible pulpitis who are undergoing endodontic treatment, what is the comparative efficacy of articaine compared with lidocaine in reducing pain and incidence of adverse events? METHODS: A protocol was prepared and registered on PROSPERO. Electronic searches were conducted in MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov by using strict inclusion and exclusion criteria. Two independent reviewers assessed eligibility for inclusion and quality. Weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared by using a random-effects model. RESULTS: Two hundred seventy-five studies were initially identified from the search; 10 double-blind, randomized clinical trials met the inclusion criteria. For combined studies, articaine was more likely than lidocaine to achieve successful anesthesia (odds ratio [OR], 2.21; 95% CI, 1.41-3.47; P = .0006; I(2) = 40%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lidocaine (OR, 3.99; 95% CI, 0.50-31.62; P = .19; I(2) = 59%). For combined mandibular anesthesia studies articaine was superior to lidocaine (OR, 2.20; 95% CI, 1.40-3.44; P = .0006; I(2) = 30%), with further subgroup analysis showing no difference for mandibular block anesthesia (OR, 1.44; 95% CI, 0.87-2.38; P = .16; I(2) = 0%). When used for supplemental infiltration after successful mandibular block anesthesia, articaine was significantly more effective than lidocaine (OR, 3.55; 95% CI, 1.97-6.39; P < .0001; I(2) = 9%). There were no reports of adverse events. CONCLUSIONS: This systematic review of double-blind, randomized clinical trials provides level 1 evidence to support the use of articaine for patients with symptomatic irreversible pulpitis. There is a significant advantage to using articaine over lidocaine for supplementary infiltration after mandibular block anesthesia but no advantage when used for mandibular block anesthesia alone or for maxillary infiltration.

Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: prospective, randomized crossover study.

AIM: Articaine and bupivacaine are both amide-type local anesthetic (LA) agents, of almost equal potency. However, lidocaine is considered the gold standard and is the most widely used anesthetic agent because of its potency, safety, and efficiency. Articaine is fast acting and bupivacaine is a long-lasting LA. The aim of this randomized controlled crossover clinical study was to evaluate and compare the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine in orthodontic extractions models. METHODS: Forty systemically healthy patients (age range: 10-18 years), requiring premolar extraction for orthodontic reasons (all 4 premolars) were included. Patients were categorized into two groups (4% articaine and 0.5% bupivacaine) in a crossover manner (160 premolars). Parameters recorded included: time of anesthetic onset, duration of postoperative analgesia, time to first rescue analgesic medication, and visual analog scale (VAS). At the first appointment, both upper and lower premolars were extracted on one side of the jaws (right or left). A fixed volume of 1.4 mL of 4% articaine or 0.5% bupivacaine (based on a computer-generated list) was infiltrated in the buccal vestibule (local infiltration) for extraction. At the second appointment, after a washout period of 15 days, the anesthetic agent that was not administered at the first appointment was administered in a crossover manner. Each patient was evaluated using a 100-mm VAS during and after extraction. RESULTS: The results showed that 4% articaine had significantly faster onset of action and lower VAS scores when compared with bupivacaine. However, the duration of analgesia and time to first rescue analgesic medication was longer in the bupivacaine group. CONCLUSION: Articaine seemed to have better potency and efficacy in terms of onset of action and lower pain scores compared to the bupivacaine group. Further studies are required to confirm these results.

Estudo comparativo entre dois protocolos anestésicos envolvendo bloqueio do nervo alveolar inferior convencional e de Vazirani-Akinosi para exodontia de terceiro molar inferior / Comparative study of two anaesthetic protocols involving conventional and Vazirani-Akinosi alveolar inferior nerve block for lower third molar extraction

Introdução: O bloqueio do nervo alveolar inferior (BNAI) apresenta alta porcentagem de falha na Odontologia. A fim de melhorar esse índice, vêm-se estudando diferentes alternativas, como diferentes técnicas e soluções anestésicas. Objetivo: Avaliar duas diferentes técnicas - técnica convencional e de Vazirani-Akinosi - para o bloqueio do nervo alveolar inferior, bem como compará-las quanto à sua efetividade e quantificar o percentual de aspirações positivas nas duas diferentes técnicas. Material e Método: Foram avaliados 160 pacientes de ambos os sexos, sendo 80 submetidos ao bloqueio do nervo alveolar inferior de Vazirani-Akinosi e bloqueio do nervo bucal (G1), e 80 submetidos ao bloqueio do nervo alveolar inferior convencional e ao bloqueio do nervo bucal (G2). Em ambos os grupos, utilizou-se a combinação de articaína 4% com epinefrina 1:100.000 para bloqueio do nervo bucal, e lidocaína 2% com epinefrina 1:100.000 para bloqueio do nervo alveolar inferior. Foram avaliados: a quantidade de aspirações positivas, a eficácia da anestesia e o momento em que ocorreu a falha anestésica durante o procedimento cirúrgico. Resultado: Não houve diferenças estatisticamente significantes (p = 0,2453) entre os grupos G1 e G2 observando-se a eficácia e o índice de aspirações positivas, e o momento em que ocorreu a falha anestésica, observando-se uma maior eficácia de ambas as técnicas, quando comparadas com a literatura (90%) Conclusão: Não houve diferença significativa entre o BNAI pela técnica convencional e o BNAI pela técnica de Vazirani-Akinosi quanto a quantidade de aspirações positivas e eficácia, sendo que o uso da articaína 4% com epinefrina 1:100.000 no bloqueio do nervo bucal possivelmente aumentou a eficácia ...

Introduction: The inferior alveolar nerve block has a high percentage of failure in dentistry. To improve this ratio, has been studied different alternatives, as different techniques, as well as anesthetics. Objective: Evaluate two different techniques (conventional technique and Vazirani-Akinosi) for inferior alveolar nerve block, and compare them regarding their effectiveness and quantify the percentage of positive aspirations in both techniques. Material and Method: 160 patients were evaluated for both sex, with 80 undergoing Vazirani-Akinosi technique plus buccal nerve block (G1), and 80 to conventional inferior alveolar nerve block plus buccal nerve block (G2), both groups using a combination of 4% articaine with 1:100.000 epinephrine to buccal nerve block and 2% lidocaine with 1:100.000 epinephrine to inferior alveolar nerve block. We evaluated the amount of positive aspirations, the effectiveness or not of anesthesia (pain) and when it occurred during the surgical procedure. Result: There were no statistically significant differences (p = 0.2453) between G1 and G2 observing the positive aspiration. It was obtained efficiency of 90% for both techniques. Conclusion: No significant difference between the conventional alveolar inferior nerve block technique and Vazirani-Akinosi alveolar nerve block technique considering the amount of positive aspirations and efficacy, and the use of 4% articaine with 1:100.000 epinephrine in buccal nerve block possibly increased the anesthetic efficacy of both techniques. .

Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego / Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study / Ropivacaína, articaína o la combinación de ropivacaína y articaína en la anestesia epidural para cesárea: estudio aleatorio, prospectivo y doble ciego

JUSTIFICATIVA E OBJETIVOS: Iniciar a anestesia peridural com anestésicos locais de longa duração consome uma quantidade significativa de tempo, o que pode ser problemático em centros de anestesia obstétrica muito movimentados. Aventamos a hipótese de que uma combinação de articaína e ropivacaína proporcionaria início mais rápido e mesmo uma recuperação precoce das características do bloqueio sensório-motor. MÉTODOS: Sessenta parturientes a termo agendadas para cesariana eletiva foram randomicamente alocadas em três grupos para receber 20 mL de articaína a 2% (Grupo A), 10 mL de articaína a 2% + 10 mL de ropivacaína a 0,75% (Grupo AR) ou 20 mL de ropivacaína a 0,75% (Grupo R) via cateter peridural. O tempo de início do bloqueio sensorial até T10-T6 e o nível máximo de bloqueio, o tempo para a regressão de dois segmentos do nível máximo de bloqueio sensorial e o tempo de início e duração do bloqueio motor foram todos registrados. A necessidade de analgésicos adicionais, intra- e pós-operatoriamente, também foi registrada. RESULTADOS: Os dados demográficos foram semelhantes. Os tempos de início do bloqueio sensorial até os níveis T10 e T6 foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p < 0,05). Os tempos de início do bloqueio motor foram semelhantes em todos os grupos, mas um bloqueio motor mais profundo foi observado no Grupo R (p < 0,05). O tempo para a regressão de dois segmentos e a duração do bloqueio motor foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p < 0,05). A necessidade de analgésico adicional no período intraoperatório foi maior no Grupo A do que nos outros dois grupos (p < 0,05). CONCLUSÃO: A combinação de 2% articaína e 0,75% ropivacaína para anestesia peridural em cesariana deve ser preferida à administração peridural de ropivacaína a 0,75% sozinha.

BACKGROUND AND OBJECTIVES: Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. METHODS: Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A), 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR) or 20 mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. RESULTS: Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p < 0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p < 0.05). CONCLUSION: A combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.

JUSTIFICATIVA Y OBJETIVOS: Iniciar la anestesia epidural con anestésicos locales de larga duración consume una cantidad significativa de tiempo, siendo un problema en los centros de anestesia obstétrica que tienen mucho movimiento. Barajamos la hipótesis de que una combinación de articaína y ropivacaína proporcionaría un inicio más rápido e incluso una rápida recuperación de las características del bloqueo sensitivo motor. MÉTODOS: Sesenta parturientes a término que tenían cita para la cesárea electiva se ubicaron aleatoriamente en tres grupos para recibir 20 mL de articaína al 2% (Grupo A), 10 mL de articaína al 2% + 10 mL de ropivacaína al 0,75% (Grupo AR) o 20 mL de ropivacaína al 0,75% (Grupo R) vía catéter epidural. Se registraron el tiempo de inicio del bloqueo sensorial hasta T10-T6 y el nivel máximo de bloqueo; el tiempo para la regresión de los segmentos del nivel máximo de bloqueo sensorial y el tiempo de inicio y duración del bloqueo motor. La necesidad de analgésicos adicionales en el intra y en el postoperatorio, también se registró. RESULTADOS: Los datos demográficos fueron parecidos. Los tiempos de inicio del bloqueo sensorial hasta los niveles T10 y T6 fueron significativamente menores en los grupos A y AR, en comparación con el Grupo R (p < 0,05). Los tiempos de inicio del bloqueo motor fueron similares en todos los grupos, pero un bloqueo motor más profundo se observó en el Grupo R (p < 0,05). El tiempo para la regresión de los segmentos y la duración del bloqueo motor fueron significativamente menores en los grupos A y AR, en comparación con el Grupo R (p < 0,05). La necesidad de analgésico adicional en el período intraoperatorio fue mayor en el Grupo A que en los otros dos grupos (p < 0,05). CONCLUSÓN: La combinación de ropivacaína al 2% y de articaína al 0,75% para la anestesia epidural en cesárea debe ser el método de preferencia en vez de la administración epidural de ropivacaína sola al 0,75%.

Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study.

BACKGROUND AND OBJECTIVES: Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. METHODS: Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A), 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR) or 20 mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. RESULTS: Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p < 0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p < 0.05). CONCLUSION: A combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.

Effect of articaine on calcium transport in sarcoplasmic reticulum membranes isolated from medial pterygoid muscle

Local anesthetics used in dentistry have myotoxic effects. Articaine, also known as carticaine, is one of the local anesthetics most widely used in clinical dentistry. The aim of this work was to describe its effect on the sarcoplasmic reticulum Ca-ATPase isolated from medial pterygoid muscle. Ca-ATPase enzymatic activity was determined by a colorimetric method and ATP-dependent calcium uptake with a radioisotopic technique. Articaine inhibited both Ca-ATPase activity and calcium uptake in a concentrationdependent manner. Both inhibitory effects became evident at articaine concentrations lower than those employed in clinical dentistry. Half-maximal inhibitory concentrations (Ki) were 15.1± 1.8 mM (n = 6) and 25.2 ± 1.6 mM (n = 6) for enzymatic activity and calcium uptake, respectively. Preincubation of sarcoplasmic reticulum membranes with articaine enhanced Ca-ATPase activity in the absence of calcium ionophore, suggesting an ionophoriclike effect of the local anesthetic. We conclude that the inhibitory effect of articaine on the sarcoplasmic reticulum Ca-ATPase isolated from medial pterygoid muscle is due to a direct interaction of the anesthetic with the enzyme and to the increased membrane permeability to calcium induced by this drug.

Los anestésicos locales de uso odontológico tienen efectos miotóxicos. La carticaína, también conocida como articaína, es uno de los anestésicos locales más usados en la clínica odontológica actual. El objetivo del trabajo fue describir el efecto de la carticaína sobre la Ca-ATPasa del retículo sarcoplásmico aislada del músculo pterigoideo interno. La actividad enzimática de la bomba de calcio se determinó por un método colorimétrico y se utilizó un método radioisotópico a fin de determinar la captación de calcio dependiente de ATP. La carticaína inhibió la actividad enzimática y la captación de calcio en función de su concentración. Ambos efectos se observaron a concentraciones de carticaína menores a las utilizadas en la clínica. Las concentraciones de carticaína necesarias para inhibir la actividad Ca-ATPásica y la captación de calcio a la mitad de su valor máximo (Ki) fueron 15.1 ± 1.8 mM (n = 6) y 25.2 ± 1.6 mM (n = 6) respectivamente. La preincubación con carticaína de las membranas de retículo sarcoplásmico del músculo pterigoideo interno, en ausencia de ionóforo de calcio, incrementó la actividad de la enzima, evidenciando un efecto ionofórico del anestésico local. Concluimos que el efecto inhibitorio de la carticaína sobre la Ca-ATPasa de retículo sarcoplásmico del músculo pterigoideo interno se debe a la acción directa del anestésico local sobre la enzima y al incremento de la permeabilidad de la membrana del retículo sarcoplásmico al calcio inducido por esta droga.

Estudo da difusão da articaína na polpa de dentes maxilares e no palato / Study of articaine diffusion into the pulp of maxillary teeth and to the palate

Objective: The purpose of this study was to assess if 4% articaine with 1:100,000 epinephrine (DFL®, Rio de Janeiro, Brazil) provides the necessary diffusion to anesthetize dental pulps innervated by the anterior and medium branches of the superior alveolar nerve as well as the nasopalatine region after posterior superior alveolar nerve block. Methods: In this descriptive and quantitative study, selected total of 30 patients was selected, with healthy superior-lateral incisors and first premolars, who were submitted to cold testing of the pulp, puncture of the nasopalatine region and identification of the stimuli on the visual analogue Faces Pain Scale. This procedure was repeated in two stages, four minutes and eight minutes after the posterior superior alveolar nerve block with articaine.Results: Eight minutes after the injection, 50% of patients reported complete absence of pain (score zero) in the lateral incisor tested, 80% in the premolar and 36.67% in the nasopalatine region. No statistically significant diffusion was recorded in either gender (p = 0.26) or between different age groups (p=0.29). Conclusion: Diffusion did not occur with the expected intensity in all patients, which does not exclude the use of anesthetic block on these nerves when an intervention is needed in the region.

Objetivo: Avaliar se a articaína a 4% com epinefrina 1:100.000 (DFL®, Rio de Janeiro, Brazil) apresenta uma difusão capaz de insensibilizar as polpas dentárias inervadas pelos ramos médio e anterior do nervo alveolar superior e insensibilizar, também, a região nasopalatina, quando utilizado o bloqueio anestésico do nervo alveolar superior posterior.Métodos: Neste estudo descritivo e quantitativo, foram selecionados 30 pacientes com incisivo lateral superior e primeiro pré-molar superior hígidos, os quais foram submetidos a teste pulpar a frio e punção na região nasopalatina e identificação dos estímulos na Escala de Faces de Dor. Este procedimento foi repetido em duas etapas: com quatro minutos e oito minutos após o bloqueio do nervo alveolar superior posterior com articaína. Resultados: Em seguida aos testes de sensibilidade, verificou-se que após oito minutos da anestesia por bloqueio, 50.00% dos pacientes referiram ausência de dor (escore zero) no incisivo lateral testado, 80.00% no pré-molar e 36,67% na região nasopalatina. Não foi registrada difusão estatisticamente significante em relação aos sexos (p = 0,26) e entre as faixas etárias analisadas (p = 0,29). Conclusão: Esta difusão não ocorreu em todos os pacientes com a intensidade esperada, o que não descarta o uso do bloqueio destes nervos quando houver necessidade de intervenção na região.

Análise comparativa entre articaína e mepivacaína na anestesia da região palatina: estudo-piloto / Comparative analysis between articaine and mepivacaine anesthesia in the palatine region: pilot study

Em um estudo analítico, do tipo ensaio clínico randomizado, prospectivo, quantitativo, comparativo, descritivo, duplo-cego, de amostras pareadas, comparou-se e analisou-se a difusibilidade dos anestésicos locais Articaína e Mepivacaína, através da anestesia no sulco vestibular e de exame clínico na região palatina, para cirurgia de terceiros molares superiores bilaterais. Uma amostra de 50 pacientes foi estudada, sendo que os resultados de 5 pacientes foram excluídos, porque eles não satisfizeram as exigências. Para o anestésico Mepivacaína, o percentual de pacientes com dor variou de 68,9% com 30 segundos a 37,8% na avaliação com 3 minutos, enquanto que, para o anestésico Articaína, o percentual de pacientes com dor variou de 37,8% com 30 segundos para 20,0% com 3 minutos. Em cada tempo de avaliação, comprova-se diferença significante entre os dois anestésicos em relação à ocorrência da dor ao nível de 5,0% (p < 0,05). Comprova-se, portanto, uma maior difusibilidade da Articaína nos tecidos, diminuindo a necessidade de uma complementação anestésica por palatino, região de grande sensibilidade dolorosa.

In an analytical study, the randomized clinical trial, prospective, quantitative, comparative, descriptive, doubleblind, paired samples, we compare and analyze the diffusibility of local anesthetics Articaine and Mepivacaine, through anesthesia on vestibular and examination clinician in the palate to upper third molar surgery bilateral. A sample of 50 patients was studied, and the results of 5 patients were excluded because they did not have met. For the anesthetic Mepivacaine, the percentage pain patients ranged from 68.9% with 30 seconds to 37.8% in the assessment to 3 minutes. While for the anesthetic Articaine, the percentage of pain patients ranged from 37.8% to 20.0% for 30 seconds and 3 minutes; each evaluation time shows a significant difference between the two anesthetics in relation to the occurrence of pain at the level of 5.0% (P <0.05). Proves, therefore, greater diffusibility of Articaine by tissue, reducing the need for anesthetic supplementation on the palatal, region of great soreness.