A prospective randomized clinical trial compared the effect of various types of local anesthetics cartridges on hypertensive patients during dental extraction

OBJECTIVES To evaluate hemodynamic changes of blood pressure and heart rate on hypertensive patients undergoing tooth extraction using various types of local anesthesia (LA). STUDY DESIGN A prospective randomized clinical trial was conducted on 45 hypertensive patients who were divided equally into 3 parallel groups according to LA received. Group 1: Lidociane 2% with epinephrine 1: 80,000. Group 2: Prilocaine 3% with Felypressin 0.03 IU/ml. Group 3: Mepivacaine 3% plain. INCLUSION CRITERIA hypertensive patients, under medical management with blood pressure ≤ 159/99. EXCLUSION CRITERIA Blood pressure ≥160 /100 and patients receiving β blockers. Negative aspiration was mandatory before the injection of 2 cartridges of LA. Blood pressure and heart rate were evaluated by Electronic Sphygmomanometer and Pulse Oximeters in 3 different time-points; 3 minutes before LA, three minutes after LA and three minutes after extraction. RESULTS The mean of systolic blood pressure (SBP) had increased after LA injection, and then decreased after extraction in the 3 groups of patients. Increase of SBP after extraction with (Mepivacaine plain) was higher than (Lidociane with Epinephrine) and the difference was statistically significant using ANOVA (p=0.037). The differences in the mean heart rates and mean diastolic blood pressures in the 3 groups were not significant. CONCLUSIONS The increase of blood pressure with Epinephrine and Felypressin is negligible. Therefore, it is safe to use 2 cartridges of Lidociane 2% with Epinephrine 1:80,000 or Prilocaine 3% with Felypressin 0.03 IU/ml for hypertensive patients whose blood pressure ≤ 159/99 provided negative aspiration is verified before injection. Key words:Local anesthesia, tooth extraction, hypertensive patients, vasoconstrictors, epinephrine, Felypressin.