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Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
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An Injectable and Drug-loaded Supramolecular Hydrogel for Local Catheter Injection into the Pig Heart
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Injectable local anaesthetic agents for dental anaesthesia.

Silvia Spivakovsky1

  • 1New York University, College of Dentistry, New York, USA. ebd@nature.com.

Evidence-Based Dentistry
|June 30, 2019
PubMed
Summary

This review found that while 4% articaine with adrenaline may be more effective than lidocaine for dental anesthesia success, high-quality evidence is limited. Further research is needed to determine optimal local anesthetic formulations.

Area of Science:

  • Dentistry
  • Anesthesiology
  • Pharmacology

Background:

  • Local anesthetics are crucial for pain management in dental procedures.
  • Determining the most effective local anesthetic formulation is essential for successful treatment outcomes.
  • Previous studies have yielded mixed results regarding the efficacy of different local anesthetic agents.

Purpose of the Study:

  • To systematically review and synthesize evidence from randomized controlled trials comparing different local anesthetic formulations used in dentistry.
  • To evaluate the efficacy and safety of various local anesthetic agents, dosages, and concentrations.
  • To identify which local anesthetic formulations provide superior outcomes for specific dental procedures.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases up to January 2018.

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  • Inclusion criteria comprised randomized controlled trials of local anesthetics in clinical or simulated dental scenarios.
  • Data extraction, risk of bias assessment, and GRADE evaluation were performed independently by two reviewers.

    • Main Results:

    • Sixty-eight studies with 6615 participants were included in the quantitative analysis.
    • Four percent articaine with 1:100,000 adrenaline showed a statistically significant advantage in success rates (absence of pain) compared to 2% lidocaine with 1:100,000 adrenaline for irreversible pulpitis (RR 1.60, 95% CI 1.10 to 2.32).
    • No significant differences were found in pain during or after injection between these two formulations. Lidocaine showed superiority over prilocaine in certain surgical and periodontal treatments.

    Conclusions:

    • There is insufficient high-quality evidence to definitively determine the most effective local anesthetic formulation.
    • Articaine 4% with 1:100,000 adrenaline demonstrated superior efficacy for achieving anesthesia success in posterior teeth with irreversible pulpitis.
    • Lidocaine 2% with 1:100,000 epinephrine was found to be superior to specific prilocaine formulations in surgical and periodontal contexts.