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Local Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Elena González Burgos, Luis Luis García-García, M. Pilar Gómez-Serranillos, Francisca Gómez Oliver
Etidocaine (Fig. 15.8) is a long-acting and rapid onset local anesthetic with a higher in vitro potency and longer duration of action than lidocaine. Etidocaine is indicated to mitigate and to reduce postoperative pain after dental procedures. Etidocaine 1.5% with epinephrine resulted to be a similar potent local anesthetic than lidocaine 2% with epinephrine when administered by inferior alveolar nerve block. However, its use in clinic is limited since it is associated with an increased risk of intraoperative and postoperative bleeding (etidocaine has vasodilator properties) and it does not produce a differential blockade of motor fibers and sensory fibers. Moreover, etidocaine is used associated with epinephrine for other diagnostic and surgical procedures (i.e., obstetrical and ophthalmic) by percutaneous infiltration, caudal anesthesia, lumbar peridural anesthesia, and peripheral nerve block. Etidocaine, particularly when it is administered by an IV injection, could produce cardiac depressant action (hypotension, bradycardia, and even heart failure). In addition, etidocaine could have neurotoxicity effects that include depression, anxiety, and neuropathy (Deupree, 2007; Rood, 1989).
Selection of Materials and Techniques
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Appropriate evaluations can be made in most primary school patients, while the answers from adolescents may be far less reliable due to anxiety. The use of a nerve stimulator and the addition of etidocaine to the anesthetic solution (resulting in motor blockade) usually reassure most anxious patients that the block is effective.
Pharmacology of local anesthetics
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2014
Pamela E. Macintyre, Stephan A. Schug
Etidocaine is as long acting as bupivacaine and has been associated with similar problems with respect to cardiac toxicity. It is noted for its profound motor blockade and therefore not used to provide analgesia.
Lipid-based carriers for the delivery of local anesthetics
Published in Expert Opinion on Drug Delivery, 2019
Daniele Ribeiro de Araújo, Lígia Nunes de Morais Ribeiro, Eneida de Paula
Aminoamide agents are more stable than aminoesters because of their hepatic metabolism [32]. PLC, mepivacaine (MVC), and articaine (ATC) are short action agents with widespread use in dentistry [33], the latter having a particular structure – with an additional ester bond and thiophene instead of a benzene ring (Figure 1) – erroneously considered to increase its hydrophobicity [34]. The commercial appeal of dibucaine (DBC) is in the control of mucosal pain, mainly for the treatment of hemorrhoids [35,36]. Etidocaine (EDC) has been banned from the market because of its alleged systemic toxicity, although this is a matter of debate [37]. The youngest member of the aminoamide family is ropivacaine (RVC), synthesized in the less toxic levorotatory S(-) enantiomeric form, to overcome the systemic toxicity of racemic BVC in surgical anesthesia [38–40].
Anaesthetic efficacy of 2% lidocaine with different concentrations of epinephrine (1:80,000 and 1:200,000) in intraligamentary injection after a failed primary inferior alveolar nerve block: a randomized double-blind study
Published in Acta Odontologica Scandinavica, 2020
Vivek Aggarwal, Mamta Singla, Masoud Saatchi, Mukesh Hasija
The intraligamentary injection was introduced by Malamed in 1982 as an alternative to the conventional inferior alveolar nerve block [12]. Since then it has been evaluated both as primary injection and as a supplementary injection [15–18]. Success rates of up to 92% have been reported with both pressure type and conventional syringes [2,11]. It has been reported that the presence of a vasoconstrictor significantly increases the duration and efficacy of intraligamentary injections [2]. Kaufman et al. [19] compared the anaesthetic efficacy of plain 2% lidocaine with 2% lidocaine with 1:50,000 epinephrine. The authors reported that the duration of anaesthesia with plain lidocaine was 1.02 min, while lidocaine with epinephrine had pulpal anaesthesia of 27.05 min. Johnson et al. [20] compared the duration of anaesthesia of 1.5% etidocaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine given as an intraligamental injection. Etidocaine gave 35% whereas lidocaine gave 55% success rates. The authors suggested that the anaesthetic efficacy in intraligamentary injections is more related to the concentration of epinephrine than the type of anaesthetic agent. A recent study compared the efficacy of 4% articaine with 1:100,000 epinephrine vs. 2% lidocaine with 1:80,000 epinephrine given as a supplemental intraligamentary injection after a failed IANB [21]. The authors reported that there was no significant difference between the anaesthetic efficacy of the two agents. Meechan [18] evaluated the anaesthetic efficacy of 2 different concentrations of plain ropivacaine vs. lidocaine containing epinephrine when given as a primary intraligamentary injection and reported that lignocaine with epinephrine was more effective than ropivacaine. The results of these studies are in accordance of the fact that the presence of vasoconstrictors will decrease the absorption of local anaesthetic solution from the highly vascular cancellous bone, thus increasing the depth and the duration of anaesthetic agent. Majority of the studies evaluating intraligamentary injections have been performed on asymptomatic teeth. Very limited research has been dedicated to the evaluation of different variables in intraliagmentary injections in patients with symptomatic irreversible pulpitis.