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PubMedDate not supplied

Periodontal ligament injection: alternative solutions.

This study was undertaken to investigate whether plain lidocaine, 3% plain mepivacaine and 3% prilocaine with felypressin were suitable epinephrine-free local anesthetic solutions for use in periodontal ligament anesthesia as alternatives to lidocaine with 1:80,000 epinephrine. Two hundred and seven patients received one of the four test solutions via a periodontal ligament injection and the success rate of anesthesia was confirmed using an electric pulp stimulator. Although neither mepivacaine nor prilocaine were as effective as lidocaine with epinephrine, the success rates of these three solutions were not statistically different. A single periodontal ligament injection of any of the solutions tested resulted in a low incidence of anesthesia. The success rate of lidocaine without epinephrine was consistently poor.

Adolescent↗
PubMed1978

Effects of local anesthetics on the respiratory activity in vitro of cells in the dental pulp.

The respiratory activity of isolated dental pulps from rat incisors was studied using a Gilson respirometer. The activity was compared with activities after administration of varying concentrations of commercial standard solutions of lidocaine with and without adrenaline and prilocaine with felypressin. Above a 2.5% concentration of the standard solution added to the respiratory medium a significant inhibition was registered.

Anesthetics, Local↗
PubMedDate not supplied

Vasoconstrictive agents commonly used in combination with local anesthetics: a literature review.

A review of the current medical literature concerning the use of various vasoconstrictive agents with local anesthetics is presented. These agents are employed in podiatry primarily for the purpose of prolonging the duration of anesthesia and surgical hemostasis. Epinephrine, phenylephrine, levonordefrin, felypressin, and norepinephrine have all been utilized in conjunction with the local anesthetics by the various medical professions. Although controversy surrounds the use of these agents, this article should assist the podiatric physician in making an informed decision.

Anesthetics, Local↗
PubMed1993

Systemic management of Marfan's syndrome during dental treatment: a case report.

Marfan's syndrome is a dominantly inherited connective tissue disorder characterized by skeletal, ocular, and cardiovascular abnormalities, such as arachnodactyly, dolichostenomelia, kyphosis, scoliosis, pectus excavatum, ectopia lentis, aortic aneurysm and dissection, aortic valve incompetence, and mitral valve prolapse. This report describes the systemic management during dental treatment of a 26-year-old man with Marfan's syndrome. Blood pressure, electrocardiogram, echocardiography, systolic time intervals, and aortic pulse wave velocity were monitored. Nitrous oxide inhalational sedation was employed. In contrast to the vasopressin, felypressin (contained in prilocaine), epinephrine (contained in lidocaine) caused an acceleration of cardiac function--increased heart rate, cardiac output, 1/pre-ejection period (PEP), and aortic pulse wave velocity and decreased PEP and left ventricular ejection time. This experience suggests that the use of anesthetics containing epinephrine in dental patients with Marfan's syndrome needs to be carefully managed.

Adult↗
PubMed1993

Prilocaine: an old anesthetic agent and a new ophthalmic procedure.

We present a new local anesthetic technique for ophthalmic surgery that reduces the risks associated with retrobulbar and peribulbar anesthesia. This method uses topical proparacaine plus 1.5 mL of prilocaine (3%) with felypressin injected into the subconjunctival (sub-Tenon's) space. Of 5210 consecutive adult patients in whom the technique was used, all demonstrated adequate analgesia. Sixty-three (1.2%) of the eyes required supplemental analgesia, provided by a single injection of prilocaine (0.5 mL). Ecchymosis and subconjunctival hemorrhage developed in 63 (1.2%) of the eyes. There were no instances of ptosis.

Adult↗
PubMed1992

Metabolic responses to oral surgery under local anesthesia and sedation with intravenous midazolam: the effects of two different local anesthetics.

The effects of epinephrine-free and epinephrine-containing local anesthetic solutions on plasma potassium and blood glucose concentrations were investigated in 20 patients undergoing oral surgery with intravenous midazolam sedation. Ten patients were randomly assigned to receive 4.4 mL of 2% lidocaine with 1:80,000 epinephrine as a local anesthetic and 10 were given 4.4 mL of 3% prilocaine with 0.03 IU/mL felypressin. There were significant changes from baseline potassium and glucose concentrations both within and between treatments in the early postinjection period. The epinephrine-containing local anesthetic significantly reduced the plasma potassium concentration 10 min after injection, by 0.16 +/- 0.20 mmol/L (mean +/- SD), and increased the blood glucose concentration at 10, 20, and 30 min (by 0.46 +/- 0.37, 0.63 +/- 0.45, and 0.56 +/- 0.28 mmol/L, respectively). Conversely, plasma potassium increased and blood glucose decreased 10, 20, and 30 min following the administration of the epinephrine-free solution. At 30 min potassium was increased by 0.24 +/- 0.16 mmol/L, and glucose was decreased by 0.23 +/- 0.16 mmol/L. It is concluded that epinephrine-free and epinephrine-containing local anesthetics differ in their metabolic effects during oral surgery with midazolam sedation.

Adult↗
PubMed1989

Do local analgesics injected at the time of third molar removal under general anaesthesia reduce significantly post operative analgesic requirements? A double-blind controlled trial.

A prospective, controlled, randomised, double-blind trial suggested that: 1. The use of bupivacaine 0.5% plain and prilocaine 3% with felypressin 0.03 i.u./ml. as peroperative local analgesics reduce postoperative pain scores recorded on the first postoperative morning (P less than 0.05). 2. Bupivacaine 0.5% plain reduces postoperative opiate requirements (P less than 0.025). 3. Patients do not find peroperative bilateral inferior alveolar and lingual nerve blocks with buccal infiltrations significantly unpleasant. Thus peri-operative bupivacaine 0.5% is a valuable adjunct to third molar removal under general anaesthesia.

Adolescent↗
PubMed1986

An echocardiographic study of patients with cardiovascular disease during dental treatment using local anesthesia.

The cardiac function of nine patients who had various cardiovascular diseases was investigated by echocardiography during dental treatment in which local anesthetics were administered. The administration of lidocaine with epinephrine enhanced the cardiac output of all patients. Increased heart rate was responsible for the increased cardiac output in four cases, whereas increased stroke volume was responsible in the other five cases. The administration of prilocaine with felypressin caused less of an increase in cardiac function than did lidocaine, with only one patient showing a significant change in cardiac dynamics.

Adolescent↗
PubMed1989

The use of high-performance liquid chromatography in the quality control of oxytocin, vasopressin and synthetic analogues.

Optimized C18 reversed-phase systems for oxytocin, desamino-oxytocin, lysine-vasopressin, ornithine-vasopressin and felypressin with gradient elution are discussed, focussing on precision, selectivity and ruggedness of the methods. Data from collaborative studies are presented, demonstrating the equivalence of high-performance liquid chromatography (HPLC) assays to bioassays. The findings suggest that HPLC is an excellent alternative to the time-consuming and less reliable animal testing.

Amino Acid Sequence↗
PubMed2005

A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control.

OBJECTIVE: The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (< or = 5 years) and more experienced practitioners were investigated. MATERIAL AND METHODS: Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test. RESULTS: Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates. CONCLUSIONS: Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.

Anesthesia, Dental↗
PubMed1994

Single medial injection peribulbar anaesthesia using prilocaine.

A prospective randomised study is reported comparing a single peribulbar injection into the medial compartment of the orbit and the standard two injection peribulbar technique. One hundred and seven patients undergoing elective intra-ocular surgery were randomly allocated to receive either a single medial injection, or two injections, using prilocaine 3% with felypressin. Akinesia and pain during surgery were assessed following the injection(s). There was no significant difference in pain during surgery and globe akinesia between the two groups. The single medial peribulbar injection is as effective as two injections using prilocaine 3%.

Aged↗
PubMed1991

Effects of mepivacaine, prilocaine and lidocaine on the induced constriction of the maxillofacial vasculature of the rat.

Infusions of mepivacaine 5 or 50 micrograms.min-1 and prilocaine 50 micrograms.min-1 for 10 min into the maxillofacial arterial vasculature of the anaesthetized rat curtailed significantly rises in infusion pressure induced by the administration of adrenaline via the same route. The effect of mepivacaine was significantly greater than that of prilocaine. Such anti-constrictory action following intraluminal infusion, also shown by lidocaine in a previous study, contrasts with the variable (dilatory or constrictory) consequences of perivascular injections of the same local anaesthetics. Moreover, the equi-constrictory effects of (a) 1.10(-3) IU felypressin and (b) 120 ng adrenaline were attenuated to the same extent by lidocaine 5 micrograms.min-1 for 10 min, demonstrating that the anti-constrictory action of local anaesthetics is not specifically anti-adrenergic as has been suggested previously.

Animals↗
PubMed1982

Mechanism of epinephrine enhancement of lidocaine-induced skeletal muscle necrosis.

Epinephrine significantly increases lidocaine-induced skeletal muscle necrosis, even in low concentrations that elicit no damage by themselves. Inasmuch as isoproterenol had no influence on lidocaine myotoxicity, a direct effect of epinephrine on muscle fibers is unlikely. Two vasoconstrictors with dissimilar mechanisms of action, phenylephrine and felypressin, duplicated the potentiating effect of epinephrine on fiber destruction in direct relation to their ability to retard lidocaine absorption from the tissue. It is concluded that the augmentation of muscle necrosis caused by epinephrine is largely due to its ability to increase exposure of skeletal muscle to the local anesthetic.

Animals↗
PubMed2000

Comparative study on anesthetic potency of dental local anesthetics assessed by the jaw-opening reflex in rabbits.

The potency of 4 local anesthetics to dental pulp was compared. Drugs were 4% articaine with 12 microgram/mL epinephrine (A12), 4% articaine with 6 microgram/mL epinephrine (A6), 2% lidocaine with 12.5 microgram/mL epinephrine (L), and 3% propitocaine with 0.03 IU/mL felypressin (P). Local anesthetics were injected into the dental root of the mandibular incisor. Electromyogram (EMG) of the digastric muscle was measured during the jaw-opening reflex induced by electrical stimulation. The disappearance of the EMG wave was judged as positive evidence of anesthesia. The determination of ED50 of the anesthetic was made by probit analysis. The ED50 of the A12 was minimal in all the tested anesthetics throughout the entire course. The potency in the A6 was 2.8 times that of the L. The potency of the A12 at the 15-minute measurement was 3.8 times that of the A6. The ED50 of the P was higher compared with those of the other 3 groups. It was concluded that articaine showed quicker onset than lidocaine and propitocaine and that there was a need to increase the dosage to attain a quick onset or to extend the duration.

Anesthetics, Local↗
PubMed1990

[Dental management of the medically compromised patient. A study of 162 cases].

Dental management of 162 cases of medically compromised patients was reviewed. Over the past 3 years and 2 months, 130 patients with certain medical problems underwent 162 cases of dental treatment under local anesthesia. In the present study, research was done chiefly on intraoperative management of these patients. The following results were obtained: 1) In the population of 130 patients, those in their 7th decade were the most numerous. Among the subjects, essential hypertension was the most common underlying disease, and the majority of the patients had accompanying cardio-vascular diseases. 2) When the pre- and post-65-year-old patient groups were compared, the latter group had a higher frequency of multiple medical problems. 3) It is suggested that, to manage patients having hypertension or ischemic heart diseases as a complication, continuous blood pressure measurement and ECG monitoring are essential. 4) Among several local anesthetics, 3% prilocaine with 0.03 U/ml felypressin was used most frequently, especially for those with cardiovascular diseases. 5) In the management of hypertensive and ischemic heart patients, nitrous oxide inhalation sedation was effective. 6) For those who required vasodilation, administration of nifedipine or nitroglycerin was effective. 7) Although one case of syncope and another in which dental treatment procedure had to be suspended were found, no severe complications were encountered.

Aged↗
PubMed1985

[Effect of elevated systemic arterial pressure on neurogenic vasoconstriction in the microcirculatory bed of rat skeletal muscles].

Vasomotor reactions produced by electrical stimulation of the sympathetic tract were studied in anesthetized rats by intravital microscopy of the skeletal muscle (extensor hallucis proprius). Experiments were made in normal and elevated blood pressure. The stimulation itself did not change BP but led to an appreciable decrease in the initial diameter of the arterioles (28.6 +/- 1.4 m). The constriction amounted to 21%. The lumen decreased by 38.9%. Injection of felypressin (Sandoz) in a dose of 6 to 8 IU/100 g produced the pressor reaction. The 27.4% rise of BP during primary phase of the pressor response inhibited the development of the neurogenic vasoconstriction which was 11.5% for arteriolar diameter and 20.4% for lumen. The data suggest that inhibition of the neurogenic vasoconstriction is caused by an increase in arteriolar pressure. Consequently the elevation of intralumen pressure is considered as a protective mechanism of the drop of the tissue blood flow because of the sympathetic vasoconstriction.

Animals↗
PubMed1993

Peribulbar and retrobulbar anesthesia with prilocaine: a comparison of two methods of local ocular anesthesia.

Prilocaine (Citanest) has been shown to be a satisfactory alternative to lignocaine, with certain important advantages, including superior diffusion. The latter may be especially important in peribulbar anesthesia, where the level of diffusion is a critical factor in providing a timely, high-quality block. In a prospective randomized study, we compared the effectiveness of peribulbar vs retrobulbar administration of prilocaine. Eighty-seven patients undergoing elective intraocular surgery were randomized to receive either retrobulbar or peribulbar anesthesia with prilocaine 3% with felypressin and hyaluronidase. Pain of injection, akinesia, and anesthesia were evaluated at predetermined intervals after injection. Except for the fact that lid akinesia occurred earlier in the peribulbar group, there was no difference in the quality or rate of onset of overall akinesia in the two groups. Nor were there any differences in the pain associated with injection. Both groups had excellent operative anesthesia and akinesia.

Aged↗