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COMPARISON OF EFFICACY OF 4% ARTICAINE WITH 1:100,000 ADRENALINE TO THAT OF 2% LIGNOCAINE WITH 1:80,000 ADRENALINE IN EXODONTIA CASES

Mukul Padhye, Charu Girotra , Punit Shah

Abstract
A single blind random study done on 50 patients, attending the exodontias department for extraction of maxillary or mandibular molars on either side of jaw using 2% Lignocaine and 4% Articaine. Comparison of efficacy of these two anesthetic solutions with a brief review on use of Articaine. Lignocaine being the safest and most commonly used anesthetic agent, with many encouraging results referring to greater efficacy of Articaine. We decided to compare the solutions of 2% lignocaine in 1:80,000 adrenalines with 4% Articaine in 1:100,000 adrenaline in exodontias cases in terms of 1.Time required for onset of action, 2. Depth of anesthesia, 3. Duration of anesthesia.

Introduction
Pain is an unpleasant experience that motivates an individual greater than any other life experience. Fear of pain has been associated with the dental treatment since ages. Effective control of pain during dental procedures has been one of the most important pre-requisite for practice of painless dentistry. The discovery of anesthesia has been a great boom to the field of dentistry and surgery in general. Lignocaine, as its properties closely match to that of ideal local anesthetic agent, is commonly used by dentists worldwide hence called `gold standard local anesthetic agent. In 1969, Rusching et al prepared a drug, Articaine, it differed from previous amide anesthetics in that it was derived from thiophine and contained thiophine ring in its molecule instead of usual benzene ring making the drug more lipophilic. Lignocaine being the safest and most commonly used anesthetic agent, with many encouraging results referring to greater efficiency of Articaine and with only one reported case study in India by Mehta Fali et al in Tata Institute of fundamental research
Professor & HOD , Asso. Professor , PG Student Dept of Oral & Maxillofacial Surgery, Dr.D.Y.Patil Dental College & Hospital, Nerul, Navi Mumbai

in 1983. Articaine hydrochloride is an amide local anesthetic 4-methyl-3[2-(propylamino)propionate]-2-thiopine carboxylic acid, methyl ester hydrochloride. It was synthesized in 1969 in Germany by Rusching et al. We decided to compare the solutions of 2% Lignocaine in 1:80,000 adrenaline with 4% Articaine in 1:100,000 adrenaline in exodontias cases.

Materials and Methods


The present study was conducted at dept of Oral and Maxillofacial surgery, Padmashree Dr. D. Y. Patil dental college and hospital, Nerul, Navi Mumbai. The study group comprised of 50 patients. Local anesthetic agents used were Lignocaine hydrochloride 2% with 1:80,000 adrenaline (Lignospan, Septodent) and Articaine hydrochloride 4% with 1:100,000 adrenaline (Septanest, Septodent) Inclusion criteria- healthy adults 18-65 years with extractions of mandibular or maxillary molars on both sides of jaw. Exclusion criteria- patients with acute infections, pregnant women, patients with history of renal, hepatic, cardiovascular or endocrine disorders, patients with history of

Scientific Journal

Vol. III-2009

- Efficacy Of Articaine To That Of Lignocaine In Exodontia Cases------------------------------Mukul Padhye et al

allergic reaction to local anesthetic and sulphides. Study was conducted in a single blind random manner on healthy individuals who required extractions of at least 2 maxillary or mandibular teeth one on each side of jaw. For all patients anesthesia was achieved by utilizing pterygomandibular block for mandibular teeth and posterior superior alveolar block for maxillary teeth. A comparative study of clinical finding related to Onset of anesthesia 1. 2. Depth of anesthesia 3. Duration of anesthesia 4. Cardiovascular response was done at end and results were compared.

Results
Sample of 50 was collected separately for 2% lignocaine with 1:80,000 adrenaline and 4% Articaine with 1:100,000 adrenaline by Descriptive statistics for Lignocaine mean 2.8200 1.5800 2.40 2.36

using a questionnaire randomly. The depth of anesthesia by achieved score was collected using poor, fair, good and excellent scores for lignocaine and Articaine. Data was collected by using age groups, sex, teeth extracted, total dose injected, and time of onset and duration of action of both the solutions. To monitor cardiovascular response to 2% lignocaine in 1:80,000 adrenaline and 4% articaine with 1:100.000 adrenaline in healthy adults of age 18-65 yrs, their blood pressure were recorded and monitered, the changes preoperative, after 5 min of injection, after 10 min, 15 min and post operative were studied. After collection of data it was analyzed by using statistical analysis. Different types of tests like T-test, ANOVA and One-way classification was applied. Chi-square test was applied for cardiovascular response.

Teeth extracted Total dose injected Time of onset(min) Duration of action(hrs)

sd 1.1373 0.49857 1.2777 0.4848

N 50 50 50 50

Descriptive statistics for Articaine mean 2.8200 1.0600 1.3200 2.92 sd 1.04511 0.2399 0.81916 0.48823 N 50 50 50 50

Teeth extracted Total dose injected Time of onset(min) Duration of action(hrs)

Paired T-Test of depth of anesthesia for Lignocaine S.E.M 0.04957 0.12219 0.07120 0.16084 0.07051 0.18070 0.06905 DF 49 49 49 49 49 49 49 T value 37.5238 6.383 6.461 11.316 8.226 7.748 27.808 Significance S S S S S S S

Achieved score Age groups Sex Teeth extracted Dose injected Time of onset of anesthesia Duration of action

Scientific Journal

Vol. III-2009

- Efficacy Of Articaine To That Of Lignocaine In Exodontia Cases------------------------------Mukul Padhye et al

Paired T-Test of depth of anesthesia for Articaine S.E.M 0.4642 0.12219 0.07120 0.14780 0.03393 0.11585 0.06857 DF 49 49 49 49 49 49 49 T value 18.956 6.383 7.584 4.330 27.707 5.870 5.250 Significance S S S S S S S

Achieved score Age groups Sex Teeth extracted Dose injected Time of onset of anesthesia Duration of action

ANOVA for Lignocaine and Articaine Sources of variation Doses injected Time of onset of action Achieved depth of anesthesia Duration df 49 49 49 49 f 3.00 3.045 3.510 3.398 Significance S S S S

CHI-square test statistics for 2% Lignocaine in 1:80,000 adrenaline in blood pressure changes Blood pressure Pre operation After 5 min After 10 min After 15 min Post operation df 11 10 11 10 10 Chi-sqaure value 56.560 28.760 17.680 17.240 18.200 Significance S S S S S

CHI-square test statistics for 4% Articaine in 1:100,000 adrenaline in blood pressure changes Blood pressure Pre operation After 5 min After 10 min After 15 min Post operation df 11 12 11 11 11 Chi-sqaure value 56.560 14.640 19.760 14.00 10.200 Significance NS NS NS NS NS

KEY df - Degrees of Freedom, NS-Not Significant, S-Significant

Discussion
To render patients insensitive to pain during operation has been a very old dream of medical profession. A study of contemporary records reveals that dentistry in the past was often a painful and even barbarous affair. Perhaps no advance in medical knowledge has alienated more human suffering than anesthesia. Cocaine was the first local anesthetic agent to be used, which was

replaced by procaine. It was commonly used local anesthetic agent, till the discovery of lignocaine. In 1978, Kaukenin S et al compared Lignocaine and Articaine in spinal anesthesia for urological procedures, showed that loss of tactile sensation and motor block began somewhat earlier with Articaine. Various studies have been done in dentistry evaluating the safety and efficacy of Articaine. Most of them proving it to be better than Lignocaine. A single blind random study was

Scientific Journal

Vol. III-2009

- Efficacy Of Articaine To That Of Lignocaine In Exodontia Cases------------------------------Mukul Padhye et al

done on 50 patients for extraction of maxillary or mandibular molars on either side of jaw were included in the study. The mean time taken by 4% Articaine with 1:100,000 adrenaline was 1.32 min 0.81(SD) as compared to 2.4 min 1.27(SD) taken by lignocaine with 1:80,000 adrenaline. The present study shows faster onset of Articaine as compared to lignocaine. The reason can be attributed to Articaine containing theophine ring instead of benzene ring as in other amide agents like Lignocaine. This increases its liposolubility. Articaine effectively penetrates tissue and is highly diffusible. To monitor the cardiovascular response to 2% lignocaine in 1:80,000 adrenaline and 4% articaine in 1:100,000 adrenaline in healthy adults of age group 18 to 65 yrs, the blood pressure changes, pre operative, after 5 min, after 10 min, after 15 min and post operative were recorded and monitered. Chi-square test is applied for both lignocaine and articaine and shows significant difference at P<0.05 in 2% lignocaine with 1:100,000 adrenaline and not significant at P> 0.05 in 4% articaine with 1:100,000 adrenaline. This shows that blood pressure variations, pre operative and post operative is less in articaine and hence safe. The mean duration of action of Articaine is 3 hrs 0.48(SD) as compared to 2.30 hrs 0.48(SD) of Lignocaine. Our study shows statistically significant difference in duration of action between Articaine and Lignocaine. A quick onset ensures completely painless surgery from the beginning. Our study is in consistence with some other studies which also shows a difference of 30 min, thus showing Articaine to be of shorter onset and longer duration of action. The present study also showed a statistically significant difference in the depth of anesthesia for Articaine and Lignocaine. Most studies have shown Articaine to be slightly more efficacious in producing successful anesthesia than Lignocaine, but the difference is usually not statistically significant. Although Articaines 4% solution only permits about half as many cartridges to be safely administered before reaching its maximum recommended dose than Lignocaine 2% solution does, Articaine shorter elimination half life may permit additional cartridges of Articaine sooner than additional cartridges of Lignocaine would be permitted.

According to literature articaine has been potential to cause methemoglobinemia, neuropathies and parasthesia. In a study by Stanely Malamed(2000) to evaluate the safety of articaine 191 to 882 patients (22%) reported at least 1 adverse event. The most common were parasthesia (0.9%), hyperesthesia (0.7%), headache (0.55%), infection (0.45), rash (0.3%) and pain (0.3%). No serious allergic type reactions were reported. Clinical tests for articaine administered as central nerve block anesthesia for urological procedure indicated no elevation of methemoglobin. Articaine should be used with caution in patients with hepatic disease and with significant impairments in cardiovascular function, since amide-type and possesses myocardial depressant properties.Safe use in pregnancy and lactation has not been established

Conclusion
A single blind random study was conducted comparing efficacy of Articaine(4% with adrenaline 1:100,000 dilution) with that of Lignocaine (2% with adrenaline to be used on OPD basis was also evaluated. According to the finding and statistical analysis Articaine showed faster onset and longer duration of action as compared to that of Lignocaine these difference were statistically significant. Depth of anesthesia was more with Articaine than Lignocaine. More number of such studies is required in India to make Articaine as popular and safer to be used as a routine anesthetic agent in dentistry. Clinicians should consider articaine as a potent anesthetic agent.

References
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- Efficacy Of Articaine To That Of Lignocaine In Exodontia Cases------------------------------Mukul Padhye et al

4. Bennett C.R. Monheims local anesthesia and pain control in dental practice CBS publishers and Distributors, 7th edition 1990;63-68,163-167,174-214-217 5. Carina Gisele Costa, Isabel Peixoto Toratomano et al. onset and duration periods of articaine and lignocaine on maxillary infiltration. Quintessence international 2005 mar;36(3): 197-99 6. Isen DA . Articaine; pharmacology and clinical use of a recently approved local anesthetic. Dent Today 2000: 19(11);72-7 7. Hass A L and Heng M K et al. blood pressure and electrocardiographic response to dental with use of local anesthesia. JADA, 1986; 113:639-42 8. Howe Geoffery and F. Ivor whitehead. Local anesthesia in dentistry. Dental practitioner handbook no.14 2nd edition, 1981,1-5

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