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. 2016 Jul-Dec;7(2):166-172.
doi: 10.4103/0975-5950.201370.

Comparing hemodynamic and glycemic response to local anesthesia with epinephrine and without epinephrine in patients undergoing tooth extractions

Paramjot Kaur  1 , Rashi Bahl  1 , Sameer Kaura  1 , Sumit Bansal  1
Affiliations

Comparing hemodynamic and glycemic response to local anesthesia with epinephrine and without epinephrine in patients undergoing tooth extractions

Paramjot Kaur et al. Natl J Maxillofac Surg. 2016 Jul-Dec.

Abstract

Introduction: Lignocaine with epinephrine as local anesthetic (LA) provides hemostasis and decreases the risk of systemic toxicity. The purpose of the present study was to investigate and compare the response of lignocaine with and without epinephrine to evaluate hemodynamic and metabolic response in normotensive and type II controlled diabetic patients.

Material and methods: A total of 50 patients (25 healthy and 25 controlled type II diabetics) undergoing multiple tooth extractions (age group of 20-80 years) were included in this prospective, randomised, clinical study. On their first visit, the patients were given 2% lignocaine HCl with 1:200,000 epinephrine, and 2% lignocaine HCl was given on the second visit, to carry out tooth extractions. Blood pressure (BP), pulse rate, oxygen saturation, and blood glucose estimations were done at definite intervals (before, immediately after, and 20 min after the administration of LA) on both the visits.

Results: The increase in blood glucose concentration following the administration of 2% lignocaine HCl with 1:200,000 epinephrine was statistically significant (P < 0.05) in controlled diabetic patients. Statistically significant variability in diastolic BP (DBP) was also noted in controlled diabetic patients. Both systolic BP and DBPs were statistically significantly elevated after the administration of 2% lignocaine HCl.

Conclusion: 2% lignocaine HCl with 1:200,000 epinephrine in type II diabetics and 2% lignocaine HCl should be used with caution in normotensive as well as type II controlled diabetic patients.

Keywords: Epinephrine; lignocaine HCl; local anesthesia; normotensive; tooth extractions; type II diabetes.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Mean systolic and diastolic blood pressure in healthy patients. SBP1, DBP1: Systolic blood pressure and diastolic blood pressure in patients treated under 2% lignocaine and epinephrine 1:200,000, SBP2, DBP2: Systolic blood pressure and diastolic blood pressure in patients treated under 2% lignocaine. ANOVA score (between groups): SBP1 (f = 2, df = 0.002, P = 0.992), DBP1 (f = 2, df = 0.036, P = 0.965), SBP2 (f = 2, df = 0.192, P = 0.826), DBP2 (f = 2, df = 0.396, P = 0.674). Paired samples t-test: Pair 1 (SBP1–SBP2): (t = 0.348, df = 0.74, P = 0.729), Pair 2 (DBP1–DBP2): (t = 1.046, df = 0.74, P = 0.299)
Figure 2
Figure 2
Mean systolic and diastolic blood pressure in controlled diabetic patients. SBP1, DBP1: Systolic blood pressure and diastolic blood pressure in controlled diabetic patients treated under 2% lignocaine and epinephrine 1:200,000, SBP2, DBP2: Systolic blood pressure and diastolic blood pressure in controlled diabetic patients treated under 2% lignocaine. ANOVA score (between groups): SBP1 (f = 2, df = 0.088, P = 0.916), DBP1 (f = 2, df = 0.380, P = 0.685), SBP2 (f = 2, df = 0.331, P = 0.719), DBP2 (f = 2, df = 0.309, P = 0.735). Paired samples t-test: Pair 1 (SBP1–SBP2): (t = 0.560, df = 0.74, P = 0.577), Pair 2 (DBP1–DBP2): (t = −2.376, df = 0.74, P = 0.020*). *Significance
Figure 3
Figure 3
Mean random blood sugar. RBSA1: Random blood sugar in healthy patients treated under 2% lignocaine and epinephrine 1:200,000, RBSA2: Random blood sugar in healthy patients treated under 2% lignocaine, RBSB1: Random blood sugar in controlled diabetic patients treated under 2% lignocaine and epinephrine 1:200,000 adrenaline, RBSB2: Random blood sugar in controlled diabetic patients treated under 2% lignocaine. ANOVA score (between groups): RBSA1 (f = 0.150, df = 2, P = 0.861), RBSA2 (f = 0.056, df = 2, P = 0.946), RBSB1 (f = 3.162, df = 2, P = 0.048*), RBSB2 (f = 1.751, df = 2, P = 0.181). *Significance
Figure 4
Figure 4
Mean peripheral finger pulse rate. PRA1: Pulse rate in healthy patients treated under 2% lignocaine and epinephrine 1:200,000, PRA2: Pulse rate in healthy patients treated under 2% lignocaine, PRB1: Pulse rate in controlled diabetic patients treated under 2% lignocaine and epinephrine 1:200,000, PRB2: Pulse rate in controlled diabetic patients treated under 2% lignocaine. ANOVA score (between groups): PRA1 (f = 0.060, df = 2 P = 0.942), PRA2 (f = 0.075, df = 2, P = 0.928), PRB1 (f = 0.021, df = 2, P = 0.979), PRB2 (f = 0.118, df = 2, P = 0.889)
Figure 5
Figure 5
Mean peripheral finger oxygen saturation. POA1: Oxygen saturation of healthy patients treated under 2% lignocaine and epinephrine 1:200,000, POA2: Oxygen saturation of healthy patients treated under 2% lignocaine, POB1: Oxygen saturation of type II diabetic patients treated under 2% lignocaine and epinephrine 1:200,000, POB2: Oxygen saturation of type II diabetic patients treated under 2% lignocaine. ANOVA score (between groups): POA1 (f = 0.438, df = 2, P = 0.647), POA2 (f = 1.197, df = 2, P = 0.308), POB1 (f = 1.007, df = 2, P = 0.370), POB2 (f = 0.175, df = 2, P = 0.840)
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