Evaluation of Safety of Lidocaine with Epinephrine In Known Hypertensive Patients Requiring Dental Surgery

Shahrukh Ahmed  Saeed; Saad  Mahmood; Dil  Rasheed; Nazir Ahmed  Khan; Sana  Ejaz; Tehmina  Maryam

doi:10.51253/pafmj.v75i4.11107

Authors

Shahrukh Ahmed Saeed Department of Oral and Maxillofacial Surgery, 20 Military Dental Centre Multan Pakistan
Saad Mahmood Department of Oral and Maxillofacial Surgery, 20 Military Dental Centre Multan Pakistan
Dil Rasheed Department of Oral and Maxillofacial Surgery, 20 Military Dental Centre Multan Pakistan
Nazir Ahmed Khan Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry/ National University of Medical Sciences (NUMS), Multan Pakistan
Sana Ejaz Department of Psychology, Combined Military Hospital Multan/National University of Medical Sciences (NUMS) Pakistan
Tehmina Maryam Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry/ National University of Medical Sciences (NUMS), Multan Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i4.11107

Keywords:

Epinephrine, Lignocaine, Hypertension

Abstract

Objective: To demonstrate safety of changes in blood pressure and heart rate in a group of hypertensive patients following administration of 3.6 ml of a 2% lignocaine with 1: 100,000 epinephrine dental local anaesthesia.

Study Design: Quasi-experimental study

Place and Duration of Study: This study was done at 20 Military Dental Centre, CIMS Dental College, Multan, Pakistan, from Jan to Jun 2023.

Methodology: The study involved 80 patients scheduled for tooth extraction in the OMFS outpatient department. Of these, 15 had stage 1 hypertension, 15 had stage 2 hypertension, and 15 were pre-hypertensive. The Control Group included 35 normotensive patients requiring tooth extraction, matched for age and sex.

Results: Out of 80 participants, 48(60.0%) were male, and the Mean age of the patients was 52.11±4.22 years. Mean of (Systolic Blood Pressure) SBP increased in all the groups after two minutes of local anesthetic injection. After five minutes, Systolic blood pressure drops off to baseline in all groups. The overall fall in SBP had a statistically significant difference before and after two and five minutes’ local anesthetic injection in all groups, as p-values < 0.05.

Conclusions: Patients with stage 2 hypertension involved in this trial had a reduction in systolic blood pressure thanks to dental local anaesthetic using epinephrine. Patients with systolic blood pressure hypertension experienced a drop of 21mm Hg, however there were no negative side effects.

Downloads

Download data is not yet available.

References

1. 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(11 Pt 1): 1376-80. https://doi.org/10.1016/s0895-7061(98)00157-5

2. Aubertin MA. The hypertensive patient in dental practice: updated recommendations for classification, prevention, monitoring, and dental management. Gen Dent 2004; 52(6): 544-552.

3. Bader JD, Bonito AJ, Shugars DA. A systematic review of cardiovascular effects of epinephrine on hypertensive dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93(6): 647-653.

https://doi.org/10.1067/moe.2002.123866

4. Holm SW, Cunningham LL, Bensadoun JE, Madsen MJ. Classification, pathophysiology, and management during outpatient sedation and local anesthesia. J Oral Maxillofac Surg 2006; 64: 111-121. https://doi.org/10.1016/j.joms.2005.09.023

5. St George G, Morgan A, Meechan J, Moles DR, Needleman I, Ng YL, et al. Injectable local anaesthetic agents for dental anaesthesia. Cochrane Database Syst Rev 2018; 7(7): CD006487. https://doi:10.1002/14651858.CD006487.pub2.

6. Gungormus M, Buyukkurt MC. The evaluation of the changes in blood pressure and pulse rate of hypertensive patients during tooth extraction. Acta Med Austriaca 2003; 30(5): 127-129.

7. Chaudhry S, Jaiswal R, Sachdeva S. Dental considerations in cardiovascular patients: A practical perspective. Indian Heart J 2016; 68(4): 572-575. https://doi:10.1016/j.ihj.2015.11.034.

8. Kriangcherdsak Y, Raucharernporn S, Chaiyasamut T, Wongsirichat N. Success rates of the first inferior alveolar nerve block administered by dental practitioners. J Dent Anesth Pain Med 2016; 16(2): 111–116.

https://doi.org/10.17245/jdapm.2016.16.2.111

9. Haghighat A, Kaviani N, Panahi R. Hemodynamic effects of 2% lidocaine with 1:80000 epinephrine in inferior alveolar nerve block. Dent Res J 2006; 3(1): 4–7.

10. Kakade AN, Joshi SS, Naik CS, Mhatre BV, Ansari A. Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial. J Dent Anesth Pain Med 2021; 21(5): 451-459.

https://doi:10.17245/jdapm.2021.21.5.451.

11. Giovannitti JA, Jr, Rosenberg MB, Phero JC. Pharmacology of local anesthetics used in oral surgery. Oral Maxillofac Surg Clin North Am 2013; 25(3): 453–465. https://doi.org/10.1016/j.coms.2013.03.003

12. Murakawa T, Koh H, Tsubo T, Ishihara H, Matsuki A. [Two cases of circulatory failure after local infiltration of epinephrine during tonsillectomy]. Masui 1998; 47(8): 955–962.

13. Massalha R, Valdman S, Farkash P, Merkin L, Herishanu Y. Fatal intracerebral hemorrhage during dental treatment. Isr J Med Sci 1996; 32(9): 774–776.

14. Managutti A, Prakasam M, Puthanakar N, Menat S, Shah D, Patel H. Comparative analysis of local anesthesia with 2 different concentrations of adrenaline: A randomized and single blind study. J Int Oral Health 2015; 7(3): 24–27

15. Sigaroodi AK, Hosseini H, Bashardoust N. Hemodynamic Charactristics Comparing 2% Lidocaine With Epinephrine and Citanest 3% With Felypressin in Lower Third Molar Surgery. J Dentomaxillofac Radiol Pathol Surg 2017; 6(4): 129-134. http://dx.doi.org/10.32598/3dj.6.4.129

16. Aliabadi E, Divanpour V, Mardani M. Changes in blood pressure and pulse rate of patients without systemic diseases following the injection of 2% lidocaine plus epinephrine 1: 80000 in an inferior alveolar nerve block-a prospective study. Ann Maxillofac Surg 2020; 10(2): 361-364.

https://doi.org/10.4103/ams.ams_187_19

17. Takahashi Y, Nakano M, Sano K, Kanri T. The effects of epinephrine in local anesthetics on plasma catecholamine and hemodynamic responses. Odontology 2005; 93: 72-79.

https://doi.org/10.1007/s10266-005-0044-y

18. MacDonald E, Drum M, Nusstein J, Fowler S, Beck M, Reader A. Anesthetic Success Using Nitrous Oxide and a Combination of Lidocaine/Clonidine for the Inferior Alveolar Nerve Block and the Effects on Blood Pressure and Pulse in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study. J Endod 2021; 47(4): 558-565.

https://doi.org/10.1016/j.joen.2020.12.014