Wednesday, February 21, 2018

Comparison of anesthetic efficacy of articaine and lidocaine during primary maxillary molar extractions in children

Article Title: Comparison of anesthetic efficacy of articaine and lidocaine during primary maxillary molar extractions in children
Author(s): Mittal et al
Journal: Pediatric Dentistry
Date: 2015; 37: 520-4
Major Topic: Local anesthetics in pediatric dentistry
Type of Article: Clinical trial
Main Purpose: This article aimed to determine if buccal infiltration with articaine could achieve adequate palatal anesthesia for extractions.
Key Points: Articaine buccal infiltration in the maxilla is not able to achieve palatal anesthesia.
·      Lidocaine
o   4.4 mg/kg with 300mg max
·      Articaine
o   7.0 mg/kg with 500mg max
o   Half life of 20-40 minutes (vs. 90 minutes for lidocaine and other amides) à decreased risk for systemic toxicity
o   1.5x the potency of lidocaine
o   Only amide local anesthetic with an ester group, so it can undergo biotransformation in the plasma and the liver
o   More lipid soluble than lidocaine à able to diffuse through tissue more reliably than other anesthetics
·      104 children age 5-13 years had maxillary molars extracted and were randomly allocated into the lidocaine or articaine group. Palatal anesthesia was not given in articaine group until after testing anesthesia on palatal 5 minutes after giving buccal infiltration. If patient was not anesthetized on palatal, palatal anesthesia was given.
·      Lidocaine group 
o   Higher facial pain values (not statistically significant)
o   More leg movement (40% vs. 23%)
o   More torso movement (12% vs. 4%)
o   More hand movement (37% vs. 12%)
o   More eye squeezing (65% vs. 42%)
o   More crying (2 children vs. none)
o   No statistically significant difference in effects on HR or BP
·      Successful palatal anesthesia with articaine was only achieved in one child. However, other articles have reported being able to successfully extract maxillary molars with only buccal infiltration of articaine but they waiting 10 minutes rather than 5 minutes. Also, these studies were conducted on adults with permanent teeth.
·      Variable results in studies could be due to the fact that the thick zygomatic process overlies the buccal roots of the primary 2nd molar in the primary and mixed dentition and prevents the access of local anesthetic agent to the target nerves

1- Articaine may make extractions more comfortable/less stimulating for children.
Assessment of Article:  Level of Evidence/Comments: II

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