Articaine and Lidocaine for Maxillary Infiltration Anesthesia - Article Example

Articaine and Lidocaine for Maxillary Infiltration Anesthesia This study was embarked on to make a comparison about the anesthetic properties of articaine hydrochloride with 1:200,000 epinephrine (Ultracain® DS) and Lidocaine with 1:80,000 epinephrine (Xylocaing-Adrenalin) for maxillary infiltration anesthesia. The study encompassed twenty healthy dental student included for double-blind study. The subjects were given 0.6 ml of each test solution at different times to test the consequences of infiltration anesthesia on the upper lateral incisor. The commencement and episode of anesthesia were examined with the help of electric pulp tester. The results calculated by the authors do not show any statistically noteworthy differences for commencement and duration of anesthesia between the articaine and Lidocaine solutions. It is manifested that, Lidocaine has been extensively used to produce local anesthesia. The authors agree that Articaine is an amide-type local anesthetic and is in use for the past 37 years also, they agree that Articaine is equivalent to, but not superior than, prilocaine for infiltration anesthesia. The authors state that results of comparative studies with lidocaine have been contradictory, because of the variation of epinephrine in anesthetic agent. Lidocaine with epinephrine is the drug of choice in clinical practice in Finland but for patients with cardiovascular disorders, articaine with its lower epinephrine content is usually chosen with the intend of evading the systemic side effects of epinephrine. The authors have specified the purpose of the study to get a comparative account for the commencement of anesthesia and the duration of action of the commonly used solutions of 4% articaine with 1:200,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine. METHODS The authors have selected twenty healthy volunteers (12 female, 8 male) with a mean age of 23.8 yr. The subjects were dental students with no history of allergic reaction to amide-type anesthetic agents and were not on regular medications and had intact lateral incisors. The authors got the protocol for the study, approved by the Ethics Committee of the University of Turku and Turku University Central Hospital. The test solutions were- 4% articaine with 1:200,000 epinephrine (Ultracain® DS, Hoechst AG, Frankfurt, Germany) and 2% lidocaine with 1:80,000 epinephrine (Xylocain ®-Adrenaline, Astra, S6dertalje, Sweden). Infiltration anesthesia of the upper lateral incisor was carried out twice in all subjects in such way that each subject received both test solutions. The interval between two infiltrations was approximately 2 wk. The study protocol was double-blind and the code was not wrecked until the statistical analysis of the data was made. The injections were given with 1ml tuberculin syringes with 26-Ga needles. The syringes were loaded by the same dental assistant each time with 0.6 ml of test solution, after which infiltration was performed every time by the same dentist with an injection time of 10s including one aspiration. The test solution was injected supraperiosteally adjacent to the apex of a lateral incisor. The authors have recorded the results with the help of an electric pulp stimulator to monitor the onset of pulpal anesthesia. The test tooth was dried and isolated with cotton rolls for studying its dimensions. The reading of the pulp excitability was calculated both before and after the injection. After infiltration anesthesia, pulpal status was measured every 20 sec in anticipation of achieving complete anesthesia with the help of stimulator. Pulp stimulator recordings were carried out in duplicate. Latency time, was recorded as the time interval between injection and the time when no response was elicited by maximal stimulation. Pulpal responsiveness was then assessed at 5-min intervals and then the authors have stopped this when sensation had clearly resumed. The authors have taken the duration of pulpal anesthesia as the time from onset of anesthesia to the time when sensation first clearly resumed. RESULTS Results were calculated using t-test for 40 infiltrations without any clinically significant side effects. The latency time with the articaine solution was 14 sec shorter and the duration of anesthesia 45 sec longer than with the lidocaine preparation which was not statistically significant. DISCUSSION The authors confirm that both local anesthetic agents tested provide adequate anesthesia rapidly and sufficiently long for minor dental procedures. In solutions containing equal concentrations of epinephrine, articaine has been found to produce faster and more prolonged anesthesia than lidocaine. For routine dental practice, lidocaine solutions with higher epinephrine concentrations are commonly used. Epinephrine in anesthetic solutions causes local vasoconstriction and prolongs the duration of anesthesia. In this study, no statistically significant differences in onset and duration of anesthesia between the test solutions were observed. The authors have used the two local anesthetic preparations because both of them are in common use. Recently, the systemic effects of epinephrine in local anesthetic agents have been discussed. Plasma epinephrine concentrations have been shown to increase more than 10-fold after administration of 3.6 ml of 2% lidocaine with 1:80,000 epinephrine. Despite increases in serum catecholamine concentrations, administration Analysis The study does not signify, why the authors have used articaine and not prilocaine for infiltration anesthesia when they had an account of its results inferior to prilocaine. Moreover their results for Lidocaine have shown some contradiction because of the variation of epinephrine. The authors have not mentioned anything about the use and mechanism of action of epinephrine apart for its cardiovascular implications. The authors have not clarified what is the significance of using different epinephrine concentrations when they are making a comparison? (4% articaine with 1:200,000 epinephrine and 2% Lidocaine with 1:80,000 epinephrine). Moreover what is the basis of selecting the mentioned concentrations of epinephrine. In the discussion part they have agreed that if epinephrine concentration is kept same then articaine is better choice as it shows long duration of anesthetic actions. The study does not mention why the authors have given the interval of 2 weeks? What is the half life of both articaine and Lidocaine? The study does not mention why they have selected 60% females and 40% males as subjects? What variation they have found between the two sexes? Is physiology making any difference in the results even the results do not show significant variation between the two anesthetic agents. The authors have not mentioned why they have used electric pulp stimulator. They could have mentioned the importance of using electric pulp stimulator in this study to convey the message to the readers about its significance to carryout similar or any further study. The information provided in the article is therefore incomplete. The study was conducted with 20 subjects and the baseline values for pulp excitability was determined every 20 seconds, but they have not mentioned for how long they have performed this measurement to provide an idea to the readers about the time interval required to get a complete anesthesia (latency time). The article is therefore incomplete in many aspects and does not hold much significance to formulate comprehensive information about the two anesthetic agents. The authors are not clear about their selection of concentration of epinephrine with articaine and Lidocaine. Most of the information they have procured from the references mentioned in the article but they have not given any substantial information in their article and therefore the study further needs investigation. Recommendations: Anesthetics http://www.drugs.com/mmx/articaine-hydrochloride-with-epinephrine.html REFERENCES 1. Winther JE, Nathalang B: Effectivity of a new local analgesic Hoe 40 045. 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