Comparison of articaine and bupivacaine/lidocaine for single medial canthus peribulbar anaesthesia.
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In a single-centre, randomized, double-blind study, we compared the efficacy of 2% articaine with that of a mixture of 0.5% bupivacaine and 2% lidocaine for peribulbar anaesthesia in cataract surgery, using a single medial canthus injection technique. Eighty-two patients were allocated randomly to receive 7-9 ml of a mixture of 0.5% bupivacaine and 2% lidocaine or an equal volume of 2% articaine with 1:200,000 epinephrine. Hyaluronidase 30 iu ml(-1) was added to both solutions. The degree of akinesia was scored 1, 5 and 10 min after the block, at the end of surgery and at discharge from the day case unit. Primary outcome measures were the difference in ocular movement scores 5 min after block and the need for supplementary inferolateral injections. There was greater akinesia in the articaine group at 5 min (P=0.01). Ten patients (24%) in the articaine group and 21 patients (51%) in the bupivacaine/lidocaine group required a supplementary injection (P=0.02). The mean (SD) volume of local anaesthetic required to achieve adequate block for surgery was 9.7 (2.1) ml in the articaine group and 11.0 (2.2) ml in the bupivacaine/lidocaine group (P=0.01). There was a faster offset of akinesia after surgery in the articaine group (P=0.01). There were no differences between groups in the incidence of reported pain or of minor complications. In our study, 2% articaine with 1:200,000 epinephrine was safe and efficacious for single medial canthus peribulbar anaesthesia. (+info)
Comparative study on anesthetic potency of dental local anesthetics assessed by the jaw-opening reflex in rabbits.
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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. (+info)
Comparison of articaine and bupivacaine/lidocaine for peribulbar anaesthesia by inferotemporal injection.
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BACKGROUND: Articaine is a novel amide local anaesthetic with a shorter duration of action than prilocaine. METHODS: In a randomized, double-blind study we compared the efficacy of 2% articaine with epinephrine 1:200,000 with a mixture of 0.5% bupivacaine and 2% lidocaine with epinephrine 1:200,000 for peribulbar anaesthesia in cataract surgery using a single inferotemporal injection. Eighty-two patients were randomly allocated to one of two groups to receive peribulbar anaesthesia with 6-7 ml of articaine or a bupivacaine/lidocaine mixture. Both solutions contained hyaluronidase 30 iu ml(-1). Ocular movement was scored at 2 min intervals up to 10 min, at the end of surgery and at time of discharge from hospital. Time to readiness for surgery and any complications (proptosis, chemosis, pain) were recorded. RESULTS: The articaine group demonstrated a rapid onset of peribulbar block with mean time (SD) to readiness for surgery of 4.2 (4.5) min compared with 7.2 (5.7) min in the bupivacaine/lidocaine group (P=0.0095). The block obtained in the articaine group was dense with eye movement scores at 2, 4, 6, 8 and 10 min all significantly reduced (P<0.01 at each interval). There was also a faster offset of the block in the articaine group (P=0.0009). There was no difference in incidence of minor complications between the groups. CONCLUSIONS: Two per cent articaine is safe and effective for peribulbar anaesthesia by inferotemporal injection and is a suitable alternative to the traditional mixture of 0.5% bupivacaine and 2% lidocaine. (+info)
Comparison of articaine and bupivacaine/lidocaine for sub-Tenon's anaesthesia in cataract extraction.
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BACKGROUND: Articaine is the most widely used local anaesthetic for dental anaesthesia in Germany, Italy and The Netherlands and has recently been introduced and licensed for dental use in the UK. We have previously shown articaine to be superior to a standard mixture of bupivacaine 0.5%/lidocaine 2% for peribulbar anaesthesia. Sub-Tenon's anaesthesia arguably provides a safer method of anaesthetic delivery for cataract surgery. A blunt cannula is used in this technique, thus greatly reducing the risk of globe perforation, intrathecal injection and sight-threatening periocular haemorrhage. METHODS: We compared articaine and bupivacaine/lidocaine for sub-Tenon's anaesthesia in cataract surgery. RESULTS: Sub-Tenon's anaesthesia using articaine 2% resulted in a more rapid onset of motor block compared with a bupivacaine/lidocaine (P=0.0076). Ocular movement scores were significantly lower from 2 min after injection until the end of surgery (P=0.031 ANOVA). CONCLUSION: Articaine 2% is safe and effective for sub-Tenon's anaesthesia and is a suitable alternative to the traditional bupivacaine 0.5%/lidocaine 2% mixture. (+info)
Articaine versus lidocaine plus bupivacaine for peribulbar anaesthesia in cataract surgery.
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BACKGROUND: We compared the efficacy and safety of articaine 2% with a mixture of lidocaine 2% and bupivacaine 0.5% without hyaluronidase for peribulbar anaesthesia in cataract surgery. METHOD: In this double-blind randomized clinical study, 58 cataract patients were allocated to receive either articaine 2% with epinephrine 1:200 000 or a mixture of equal parts of lidocaine 2% with epinephrine 1.25:100 000 and bupivacaine 0.5%. Ocular and eyelid movement scores, the number of supplementary injections, total volume of solution used and pain and complications during injection and surgery were used as clinical end-points. RESULTS: Articaine produced greater akinesia after 5 min (P=0.03). Eighteen patients (60%) in the articaine group and 26 (93%) in the lidocaine/bupivacaine group required a second injection (P=0.003). A third injection was needed by two patients (7%) in the articaine group and 12 (43%) in the lidocaine/bupivacaine group (P=0.001). The total mean volume of local anaesthetic required to achieve akinesia was mean 9.4 (SD 1.7) ml in the articaine group and 11.28 (1.86) ml in the lidocaine/bupivacaine group (P<0.001). Median pain score was lower in the articaine group than in lidocaine/bupivacaine group during injection (P=0.004) and surgery (P=0.014). There was no difference between the groups for the incidence of complications. CONCLUSION: Articaine 2% without hyaluronidase is more advantageous than a mixture of lidocaine 2% and bupivacaine 0.5% without hyaluronidase for peribulbar anaesthesia in cataract surgery. (+info)
Comparison of effectiveness of 4% articaine associated with 1: 100,000 or 1: 200,000 epinephrine in inferior alveolar nerve block.
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This comparative study using 20 healthy volunteers evaluated the anesthetic efficacy of 4% articaine in association with 2 different concentrations of epinephrine, 1:200,000 (G1) and 1:100,000 (G2). The first premolars were tested with a pulp tester to verify the anesthesia induced by the inferior alveolar nerve block. The following parameters were measured: period of latency (PL; interval between the end of anesthetic injection and absence of response to the maximum output--80 reading--of the pulp tester); complete pulpal anesthesia (CPA; period in which the subject had no response to maximal output of the pulp tester 80 reading); partial anesthesia (PA; interval between the first reading below 80 and the return to basal levels); and the anesthesia of the soft tissues (AST; period of time from onset of anesthesia until the return to normal sensation of the lip). The Wilcoxon test (alpha = 0.05) was used to analyze the data. No significant difference was found regarding PL (P = .47), CPA (P = .88), PA (P = .46), and AST (P = .85). The results indicated that both solutions presented the same clinical effectiveness in blocking the inferior alveolar nerve. (+info)
Comparative analysis of tissue reactions to anesthetic solutions: histological analysis in subcutaneous tissue of rats.
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Postanesthetic pain is a relatively common complication after local anesthesia. This complication may be caused by the anesthetic technique or by the anesthetic solution used. Tissue reactions induced by the anesthetic solutions may be one of the factors resulting in pain after anesthesia. The objective of this study was to comparatively analyze tissue reactions induced by different anesthetic solutions in the subcutaneous tissue of rats. The following solutions were utilized: 2% lidocaine without vasoconstrictor; a 0.5% bupivacaine solution with 1:200,000 adrenaline; a 4% articaine solution and 2% mepivacaine, both with 1:100,000 adrenaline; and a 0.9% sodium chloride solution as a control. Sterilized absorbent paper cones packed inside polyethylene tubes were soaked in the solutions and implanted in the subcutaneous region. The sacrifice periods were 1, 2, 5, and 10 days after surgery. The specimens were prepared and stained with hematoxylin and eosin for histological analysis. The results showed that there is a difference in tissue irritability produced by the local anesthetic solutions. The results also showed that there is no relation between the concentration of the drug and the inflammatory intensity, that the mepivacaine and articaine solutions promoted less inflammatory reaction than the bupivacaine, and that the lidocaine solution produced the least intense inflammation. (+info)
Influence of different vehicles on the pH of calcium hydroxide pastes.
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The main known benefit of calcium hydroxide as an intracanal medicament lies in the bactericidal effect conferred by its pH. The objective of this work was to determine the influence of the vehicle on the pH of calcium hydroxide pastes after usage in patients and in vitro. The incisor root canals of 180 patients were instrumented and filled with calcium hydroxide pastes containing distilled water, chlorhexidine, propylene glycol, anesthetic solution, camphorated p-monochlorophenol and camphorated p-monochlorophenol-propylene glycol. The pH of the paste in the patients' root canals was measured at 7, 14 and 21 days. Similarly, pH was measured in vitro up to 21 days. The pH of all the pastes remained constant throughout the time periods assessed. The calcium hydroxide-water combination showed significantly higher pH values than the other pastes in clinical use. Comparative analysis showed that the pH values of the anesthetic solution, camphorated p-monochlorophenol and camphorated p-monochlorophenol-propylene glycol were significantly higher in vitro. The type of vehicle was shown to influence the final pH of the pastes. However, the alkalinity of all pastes was maintained over time under the experimental conditions. (+info)