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Karm MH, Park FD, Kang M, Kim HJ, Kang JW, Kim S, Kim YD, Kim CH, Seo KS, Kwon KH, Kim CH, Lee JW, Hong SW, Lim MH, Nam SK, Cho JM. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial. Medicine (Baltimore) 2017; 96:e6753. [PMID: 28538371 PMCID: PMC5457851 DOI: 10.1097/md.0000000000006753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. METHODS Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups. RESULTS There were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01). CONCLUSION The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.
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Affiliation(s)
| | - Fiona Daye Park
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Moonkyu Kang
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Jeong Wan Kang
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul
| | - Seungoh Kim
- Department of Dental Anesthesiology, Dankook University College of Dentistry, Dankook University, Cheonan-si, Chungnam
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University and Institute of Translational Dental Sciences, Pusan National University
| | - Cheul-Hong Kim
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Gyeongnam
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry
| | - Kyung-Hwan Kwon
- College of Dentistry, Wonkwang University, Iksan city, Jeonbuk
| | - Chul-Hwan Kim
- Department of Oral and Maxillofacial Surgery, Dankook University College of Dentistry, Dankook University, Cheonan-si, Chungnam
| | - Jung-Woo Lee
- Department of Oral & Maxillofacial Surgery, Kyung Hee University Dental Hospital Kyung Hee University School of Dentistry, Seoul
| | - Sung-Woon Hong
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
| | - Mi Hyoung Lim
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
| | - Seung Kwan Nam
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
| | - Jae Min Cho
- R&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea
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