Comparison of the Efficacy Between Articaine and Lignocaine in Simultaneous Bilateral Orthodontic Maxillary Premolar Extractions: A Split-Mouth Comparative Study

Introduction Local anesthesia plays a crucial role in ensuring patient comfort during orthodontic extractions. Among the various local anesthetic agents commonly used in the field of oral surgery are articaine and lidocaine, which differ in their duration of action and pain effectiveness (pain control) during surgical procedures. This article aimed to analyze the characteristics of 2% lignocaine with 1:80000 adrenaline and 4% articaine with 1:100000 adrenaline regarding duration of action and pain control in patients undergoing bilateral orthodontic maxillary premolar extractions. Materials and methods A split-mouth comparative study was conducted at Saveetha Dental College and Hospitals, Chennai, for which 50 patients of age less than 30 years and who required bilateral orthodontic premolar extractions were selected. Approximately 4% articaine hydrochloride solution was administered on one side, and 2% lignocaine hydrochloride was administered on the contralateral side. Palatal infiltration was not given in the articaine group. The degree of extraction difficulty was similar in both groups, with no discernible variation. In each patient, the duration of anesthesia and pain control were assessed. The IBM Statistical Package for Social Sciences (SPSS version 24.0, IBM SPSS Statistics for Windows, Armonk, NY) was used to perform the student's paired t-test for detecting the difference in outcome parameters between the two groups. Results Upon comparing both groups, it was concluded that the articaine group had a longer mean anesthetic duration of action of 217 minutes, whereas for the lignocaine group, it was 169 minutes, and greater pain reduction was present with the articaine group. The articaine group exhibited less pain (superior pain control) with a mean visual analogue scale (VAS) score of 1.07 compared to that of the lignocaine group with a mean VAS score of 1.53 during orthodontic premolar extractions. Both the results were statistically significant (P=0.001). Conclusion This split-mouth comparative study concludes that articaine is a more effective local anesthetic in terms of duration of action and pain reduction than that of lignocaine, and it can be used as a local anesthetic of choice for orthodontic maxillary premolar extractions.

Pharmacokinetics, efficacy and convulsive dose of articaine hydrochloride in goat kids

OBJECTIVE

To investigate the pharmacokinetics, efficacy and convulsive dose of articaine hydrochloride in goat kids.

STUDY DESIGN

Experimental prospective study.

ANIMALS

A total of 18 (n = 6 animals per experiment) male Saanen goat kids (2-4 weeks old).

METHODS

The study consisted of three experiments. The first determined the pharmacokinetics of articaine following intravenous administration of articaine hydrochloride (8 mg kg^-1). The second experiment investigated the anaesthetic efficacy and pharmacokinetics following cornual nerve block using 1.5% articaine hydrochloride. Anaesthesia of horn buds was evaluated using the response to pinprick test. Non-compartmental analysis was used. The final experiment determined the convulsive dose of articaine and its corresponding plasma concentration following intravenous infusion of articaine hydrochloride (4 mg kg^-1 minute^-1). Data are shown as mean ± standard deviation.

RESULTS

The mean terminal half-life (t_1/2λz), mean volume of distribution at steady state (Vd_ss) and mean plasma clearance (CL) of articaine following intravenous administration were 0.66 hour, 3.81 L kg^-1 and 5.33 L hour^-1 kg^-1, respectively. After cornual nerve block, the mean maximum plasma concentration of articaine was 587 ng mL^-1 at 0.22 hour and its mean t_1/2λz was 1.26 hours. Anaesthesia of horn buds was observed within 4 minutes following cornual nerve block. The mean dose required to produce convulsions was 16.24 mg kg^-1 and mean convulsive plasma concentrations of articaine and articainic acid were 9905 and 1517 ng mL^-1, respectively.

CONCLUSIONS

Intravenous administration of 8 mg kg^-1 of articaine hydrochloride did not cause any adverse effects. Pharmacokinetic data suggest that articaine was rapidly eliminated and cleared. Cornual nerve block using 1.5% articaine hydrochloride alleviated the response to the acute nociceptive stimulus during disbudding.

CLINICAL RELEVANCE

Articaine hydrochloride appears to be a safe and effective local anaesthetic for disbudding in goat kids.

Pressure Algometry Validation and Determination of Efficacy of Articaine Hydrochloride Ring Block in Antler Removal in Red Deer (Cervus elaphus)

Simple Summary

Red deer (Cervus elaphus) are farmed in New Zealand for the production of velvet antler. Velvet is harvested as living antler tissue, and currently lignocaine is the only licensed local anaesthetic approved for deer antler removal in New Zealand. The use of lignocaine is not without consequences, including drug residues in harvested velvet antler tissue and its short acting analgesic effect. This study was designed to determine the effect of local anaesthetic, articaine hydrochloride as an alternative treatment and to establish the baseline measurements of mechanical nociceptive threshold in 40 male yearling red deer. Ten of the forty enrolled deer were selected for the articaine efficacy study. The mechanical nociceptive thresholds were measured using a handheld algometer applied at 4 points; the cranial, medial, caudal and lateral aspects of the base of each antler. The force applied, which resulted in a movement by the animal, was recorded in newtons (N). This study showed that nociceptive threshold response in deer could be reliably measured, and articaine proved to be a promising alternative for velveting the deer antlers.

Abstract

New Zealand deer farming centres on the production of meat and velvet antler. Velvet antler removal is a painful procedure and currently, New Zealand Animal Welfare regulations dictate surgical removal of velvet antlers under lignocaine anaesthesia. To improve our knowledge on the efficacy and duration of other local anaesthetics to mitigate pain after antler removal, it is important to accurately assess and quantify pain arising from antler removal. Therefore, the current study was designed to validate mechanical nociceptive threshold (MNT) testing using a Wagner hand-held algometer, and to apply this methodology to assess the efficacy and duration of action of articaine for antler removal in deer. Baseline force (N) required to elicit the nociceptive response was recorded in 40 yearling male red deer on three alternate days. Ten of the 40 animals were selected for antler removal after administration of 4% articaine hydrochloride as a ring block. The duration of analgesic efficacy of articaine was assessed by algometry across 5 time points. There was a significant difference in MNTs among the three days (day 3 versus day 1 (p < 0.0001), day 2 versus day 1 (p < 0.0001), and day 1 versus day 2 (p < 0.01)). Positive correlations were observed between weight, antler length and thresholds. The MNT values remained above 20N for 6 h after removal of velvet antlers under the articaine ring block. This study provides valuable information about the use of MNT in red deer. These findings lay a foundation for future studies in the topics of peri-operative and postoperative pain management in deer antler removal, and a possible alternative use for articaine.