Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study
We assessed the effect of 2% lidocaine with 1:80,000 adrenaline (L + AD) and 3% prilocaine with 0.03 IU/mL felypressin (P + FP) on blood pressure and heart rate in older adults with systemic diseases undergoing dental extraction. This double-blind, randomized crossover study included 22 elderly participants, aged over 65 years. The participants were administered L + AD for one dental extraction and P + FP for the other. Blood pressure and heart rate were recorded immediately, 5, and 10 minutes after local anesthetic administration and the data were analyzed. The systolic and diastolic blood pressures in the P + FP group increased at all measurement points (p < .001). In the L + AD group, the diastolic blood pressure decreased at 5 and 10 minutes after local anesthetic administration (p < .05), whereas the heart rate increased at all measured time points (p < .001). There were statistically significant differences in systolic blood pressure at 5 and 10 minutes after local anesthetic administration and in diastolic blood pressure and heart rate at all time points between the 2 groups. In older adults, P + FP administration increased the systolic and diastolic blood pressures. L + AD administration increased the heart rate and decreased the diastolic blood pressure.
Changes in systolic blood pressure after injection of 3.6 mL of 2% lidocaine with 1:80,000 adrenaline (L + AD) or 3.6 mL of 3% prilocaine with 0.03 IU/mL felypressin (P + FP). The 2-way repeated-measures analysis of variance showed a significant association between time after local anesthetic injection and systolic blood pressure (p < .01). The multiple comparison analysis showed that the systolic blood pressure in the P + FP group was significantly increased at all measurement points after local anesthesia compared to the baseline (p < .001). On the other hand, the systolic blood pressure was increased from baseline at LA0 (p < .05) in the L + AD group; however, it was not significantly increased at LA5 and LA10 compared to the baseline. There was a statistically significant difference in systolic blood pressure between the P + FP and L + AD groups at the time points LA5 and LA10 (LA5: P + FP, 140.8 mm Hg [SD, 12.5 mm Hg; range, 128.3–153.3 mm Hg]; LA5: L + AD, 134.2 mm Hg [SD: 14.5 mm Hg; range, 119.7–148.7 mm Hg]; LA10: P + FP, 142.5 mm Hg [SD, 13.4 mm Hg; range, 129.1–155.9 mm Hg]; LA10: L + AD, 131.5 mm Hg [SD, 13.4 mm Hg; range, 118.1–144.9 mm Hg]). LA0 indicates end of local anesthetic injection; LA5, 5 minutes after local anesthetic injection; LA10, 10 minutes after local anesthetic injection.
Changes in diastolic blood pressure after injection of 3.6 mL of 2% lidocaine with 1:80,000 adrenaline (L + AD) or 3.6 mL of 3% prilocaine with 0.03 IU/mL felypressin (P + FP). The 2-way repeated-measures analysis of variance showed a significant association between time after local anesthetic injection and diastolic blood pressure (p < .001). Diastolic blood pressure in the P + FP group was significantly increased after local anesthesia compared to the baseline (p < .001). On the other hand, in the L + AD group, there was a significant decrease in diastolic blood pressure at LA5 and LA10 compared to the baseline (p < .05). There was a statistically significant difference in diastolic blood pressure between the P + FP and L + AD groups at all time points (LA0: P + FP, 78.7 mm Hg [SD, 8.8 mm Hg; range, 69.9–87.5 mm Hg]; LA0: L + AD, 69.6 mm Hg [SD, 7.8, range 61.8–77.4 mm Hg]; LA5: P + FP, 78.7 mm Hg [SD, 8.9 mm Hg; range, 69.8–87.6 mm Hg]; LA5: L + AD; 68.2 mm Hg [SD, 9.5 mm Hg; range, 58.7–77.7 mm Hg]; LA10: P + FP, 77.8 mm Hg [SD, 8.4 mm Hg; range, 69.4–86.2 mm Hg]; LA10: L + AD, 69.2 mm Hg [SD, 9.7, range 59.5–78.9 mm Hg]). LA0 indicates end of local anesthetic injection; LA5, 5 minutes after local anesthetic injection; LA10, 10 minutes after local anesthetic injection.
Changes in heart rate after injection of 3.6 mL of 2% lidocaine with 1:80,000 adrenaline (L + AD) or 3.6 mL of 3% prilocaine with 0.03 IU/mL felypressin (P + FP). The 2-way repeated-measures analysis of variance showed a significant association between time after local anesthetic injection and heart rate (p < .001). In the multiple comparison analysis, the heart rate increased at all measured time points after local anesthesia in the L + AD group compared to the baseline (p < .001). The P + FP group showed no significant association with heart rate at all measured time points. There were statistically significant differences in heart rate between the P + FP and L + AD groups at all time points (LA0: P + FP, 78.7 beats per minute [bpm] [SD, 8.8 bpm; range, 69.9–87.5 bpm]; LA0: L + AD, 69.6 bpm [SD, 7.8 bpm; range, 61.8–77.4 bpm]; LA5: P + FP, 78.7 bpm [SD, 8.9 bpm; range, 69.8–87.6 bpm]; LA5: L + AD; 68.2 bpm [SD, 9.5 bpm; range, 58.7–77.7 bpm]; LA10: P + FP, 77.8 bpm [SD, 8.4 bpm; range, 69.4–86.2 bpm]; LA10: L + AD, 69.2 bpm [SD, 9.7 mm Hg; range 59.5–78.9 bpm]). LA0 indicates end of local anesthetic injection; LA5, 5 minutes after local anesthetic injection; LA10, 10 minutes after local anesthetic injection.
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