Comparative Assessment of the Effects of Three Local Anesthetics: Lidocaine, Prilocaine, and Mepivacaine on Blood Pressure Changes in Patients with Controlled Hypertension.

Seyyed Hamed Jalalian Hashemi,Shamsodin Rigi Ladez,Somaye Ansari Moghadam

doi:10.5539/gjhs.v8n10p227

Seyyed Hamed Jalalian Hashemi, Shamsodin Rigi Ladez + Show 1 more

Open Access

https://doi.org/10.5539/gjhs.v8n10p227

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Abstract

Given large number of patients with hypertension attending dental clinics and the profound effects of local anesthetics containing vasoconstrictors, this study aimed to compare the effects of lidocaine 2% + epinephrine, prilocaine 3% + felypressin0.03, and mepivacaine 3% on blood pressure changes. The current study was carried out from May 2014 to February 2015.Patients with controlled hypertension (systolic blood pressure<159.94 mmHg before the injection) who attended Zahedan dental school (Zahedan , Iran) for the extraction of a mandibular tooth were selected and randomly allocated to three groups of 20. Groups 1-3 received lidocaine 2% + epinephrine, prilocaine 3% + felypressin 0.03 units, and mepivacaine3%, respectively. Patients were only included if they were injected with a maximum of two 1.8 ml cartridges (3.6 ml) for tooth extraction (maximum epinephrine dose of 0.04 mg was maintained in systemic patients).The collected data were analyzed using the analysis of variance (ANOVA) in SPSS 19.0. (SPSS Inc., Chicago, IL, USA)RESULTS: No significant differences were observed between the systolic and diastolic blood pressure of the three groups. The three evaluated local anesthetic solutions had similar effects in patients with controlled hypertension. While no significant changes in blood pressure were observed in three groups, all dental procedures on the mentioned group of patients have to be performed under careful monitoring and aspiration. Moreover, the maximum epinephrine dose (0.04mg) should never be exceeded in these patients.

Highlights

Supplementing local anesthetics with a vasoconstrictor will promote the success of anesthesia by increasing its depth and duration and facilitating homeostasis (Jastak & Yagield, 1983)
While no significant changes in blood pressure were observed in three groups, all dental procedures on the mentioned group of patients have to be performed under careful monitoring and aspiration
Blood pressure analyses showed that the mean systolic blood pressure for all three anesthetics was higher immediately after the injection as compared the other two times .The values before the injection were higher than those five minutes after the injection

Summary

Introduction

Supplementing local anesthetics with a vasoconstrictor (epinephrine or adrenaline) will promote the success of anesthesia by increasing its depth and duration and facilitating homeostasis (Jastak & Yagield, 1983). Individuals receiving antihypertensive treatments are called hypertensive even if they have controlled blood pressure (Lioyd-Jones et al, 2010). The administration of epinephrine in hypertensive patients is associated with an increased risk (Bader, Bonito, & Shugars, 2002), as it can elevate the already raised systolic blood pressure and cause acute hypertensive crisis, hypertensive encephalopathy, brain hemorrhage, and acute left ventricular failure(Lioyd-Jones et al, 2010). Given large number of patients with hypertension attending dental clinics and the profound effects of local anesthetics containing vasoconstrictors, this study aimed to compare the effects of lidocaine 2% + epinephrine, prilocaine 3% + felypressin0.03, and mepivacaine 3% on blood pressure changes

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