Long-acting local anesthetics in dentistry.

Department of Oral and Maxillofacial Surgery, Medical College of Georgia School of Dentistry, Augusta 30912.

Abstract

Long-acting local anesthetics have proved to be effective for the suppression of both intraoperative and postoperative pain. They are useful for lengthy dental treatments and for prevention of severe pain following many types of surgical procedures. Although the currently available long-acting local anesthetics for dentistry have minimal side effects in the doses usually employed, there are potential problems. Bupivacaine, for example, can cause significant cardiac depressant and dysrhythmogenic responses. Etidocaine has less pronounced effects on the cardiovascular system, but its use may be associated with inadequate control of intraoperative bleeding. A new long-acting local anesthetic, ropivacaine, appears to offer advantages over either of the currently used long-acting agents.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

• Covino BG. Ultralong-acting local anesthetic agents. Anesthesiology. 1981 Apr; 54 (4):263–264. [PubMed] [Google Scholar]
• Gangarosa LP., Sr Newer local anesthetics and techniques for administration. J Dent Res. 1981 Aug; 60 (8):1471–1480. [PubMed] [Google Scholar]
• TRUANT AP, TAKMAN B. Differential physical-chemical and neuropharmacologic properties of local anesthetic agents. Anesth Analg. 1959 Nov-Dec; 38 :478–484. [PubMed] [Google Scholar]
• Tucker GT, Boyes RN, Bridenbaugh PO, Moore DC. Binding of anilide-type local anesthetics in human plasma. I. Relationships between binding, physicochemical properties, and anesthetic activity. Anesthesiology. 1970 Sep; 33 (3):287–303. [PubMed] [Google Scholar]
• Butterworth JF, 4th, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology. 1990 Apr; 72 (4):711–734. [PubMed] [Google Scholar]
• Pricco DF. An evaluation of bupivacaine for regional nerve block in oral surgery. J Oral Surg. 1977 Feb; 35 (2):126–129. [PubMed] [Google Scholar]
• Laskin JL, Wallace WR, DeLeo B. Use of bupivacaine hydrochloride in oral surgery-a clinical study. J Oral Surg. 1977 Jan; 35 (1):25–29. [PubMed] [Google Scholar]
• Feldmann G, Nordenram A. Marcaine in oral surgery. A clinical comparative study with carbocaine. Acta Anaesthesiol Scand Suppl. 1966; 23 :409–413. [PubMed] [Google Scholar]
• Danielsson K, Evers H, Holmlund A, Kjellman O, Nordenram A, Persson NE. Long-acting local anaesthetics in oral surgery. Clinical evaluation of bupivacaine and etidocaine for mandibular nerve block. Int J Oral Maxillofac Surg. 1986 Apr; 15 (2):119–126. [PubMed] [Google Scholar]
• Covino BG, Giddon DB. Pharmacology of local anesthetic agents. J Dent Res. 1981 Aug; 60 (8):1454–1459. [PubMed] [Google Scholar]
• Feldmann G, Nordenram A. Marcaine in oral surgery. A clinical comparative study with carbocaine. Acta Anaesthesiol Scand Suppl. 1966; 23 :409–413. [PubMed] [Google Scholar]
• Helldén L, Blomberg S, Woxberg B, Ohman A. A controlled trial of a long-acting local anaesthetic (Marcaine) in oral surgery for relief of post-operative pain. Sven Tandlak Tidskr. 1974; 67 (4):223–228. [PubMed] [Google Scholar]
• Trieger N, Gillen GH. Bupivacaine anesthesia and post-operative analgesia in oral surgery. Anesth Prog. 1979 Jan-Feb; 26 (1):20–23. [PMC free article] [PubMed] [Google Scholar]
• Nespeca JA. Clinical trials with bupivacaine in oral surgery. Oral Surg Oral Med Oral Pathol. 1976 Sep; 42 (3):301–307. [PubMed] [Google Scholar]
• Moore PA, Dunsky JL. Bupivacaine anesthesia--a clinical trial for endodontic therapy. Oral Surg Oral Med Oral Pathol. 1983 Feb; 55 (2):176–179. [PubMed] [Google Scholar]
• Dunsky JL, Moore PA. Long-acting local anesthetics: a comparison of bupivacaine and etidocaine in endodontics. J Endod. 1984 Sep; 10 (9):457–460. [PubMed] [Google Scholar]
• Chapman PJ, Ganendran A. Prolonged analgesia following preoperative bupivacaine neural blockade for oral surgery performed under general anesthesia. J Oral Maxillofac Surg. 1987 Mar; 45 (3):233–235. [PubMed] [Google Scholar]
• Rosenquist JB, Rosenquist KI, Lee PK. Comparison between lidocaine and bupivacaine as local anesthetics with diflunisal for postoperative pain control after lower third molar surgery. Anesth Prog. 1988 Jan-Feb; 35 (1):1–4. [PMC free article] [PubMed] [Google Scholar]
• Edde RR, Deutsch S. Cardiac arrest after interscalene brachial-plexus block. Anesth Analg. 1977 May-Jun; 56 (3):446–447. [PubMed] [Google Scholar]
• Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979 Oct; 51 (4):285–287. [PubMed] [Google Scholar]
• Mallampati SR, Liu PL, Knapp RM. Convulsions and ventricular tachycardia from bupivacaine with epinephrine: successful resuscitation. Anesth Analg. 1984 Sep; 63 (9):856–859. [PubMed] [Google Scholar]
• de Jong RH, Bonin JD. Deaths from local anesthetic-induced convulsions in mice. Anesth Analg. 1980 Jun; 59 (6):401–405. [PubMed] [Google Scholar]
• de Jong RH, Ronfeld RA, DeRosa RA. Cardiovascular effects of convulsant and supraconvulsant doses of amide local anesthetics. Anesth Analg. 1982 Jan; 61 (1):3–9. [PubMed] [Google Scholar]
• Liu P, Feldman HS, Covino BM, Giasi R, Covino BG. Acute cardiovascular toxicity of intravenous amide local anesthetics in anesthetized ventilated dogs. Anesth Analg. 1982 Apr; 61 (4):317–322. [PubMed] [Google Scholar]
• Kotelko DM, Shnider SM, Dailey PA, Brizgys RV, Levinson G, Shapiro WA, Koike M, Rosen MA. Bupivacaine-induced cardiac arrhythmias in sheep. Anesthesiology. 1984 Jan; 60 (1):10–18. [PubMed] [Google Scholar]
• Moller R, Covino BG. Cardiac electrophysiologic properties of bupivacaine and lidocaine compared with those of ropivacaine, a new amide local anesthetic. Anesthesiology. 1990 Feb; 72 (2):322–329. [PubMed] [Google Scholar]
• Arthur GR, Feldman HS, Covino BG. Comparative pharmacokinetics of bupivacaine and ropivacaine, a new amide local anesthetic. Anesth Analg. 1988 Nov; 67 (11):1053–1058. [PubMed] [Google Scholar]
• Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and lidocaine in the conscious dog. Anesth Analg. 1989 Dec; 69 (6):794–801. [PubMed] [Google Scholar]
• Tucker GT. Pharmacokinetics of local anaesthetics. Br J Anaesth. 1986 Jul; 58 (7):717–731. [PubMed] [Google Scholar]
• Nancarrow C, Rutten AJ, Runciman WB, Mather LE, Carapetis RJ, McLean CF, Hipkins SF. Myocardial and cerebral drug concentrations and the mechanisms of death after fatal intravenous doses of lidocaine, bupivacaine, and ropivacaine in the sheep. Anesth Analg. 1989 Sep; 69 (3):276–283. [PubMed] [Google Scholar]
• Nath S, Häggmark S, Johansson G, Reiz S. Differential depressant and electrophysiologic cardiotoxicity of local anesthetics: an experimental study with special reference to lidocaine and bupivacaine. Anesth Analg. 1986 Dec; 65 (12):1263–1270. [PubMed] [Google Scholar]
• Atlee JL, 3rd, Bosnjak ZJ. Mechanisms for cardiac dysrhythmias during anesthesia. Anesthesiology. 1990 Feb; 72 (2):347–374. [PubMed] [Google Scholar]
• Lacombe P, Blaise G, Hollmann C, Tanguay M, Loulmet D. Isoproterenol corrects the effects of bupivacaine on the electrophysiologic properties of the isolated rabbit heart. Anesth Analg. 1991 Jan; 72 (1):70–74. [PubMed] [Google Scholar]
• Kasten GW, Martin ST. Bupivacaine cardiovascular toxicity: comparison of treatment with bretylium and lidocaine. Anesth Analg. 1985 Sep; 64 (9):911–916. [PubMed] [Google Scholar]
• Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology. 1985 Apr; 62 (4):396–405. [PubMed] [Google Scholar]
• Thomas RD, Behbehani MM, Coyle DE, Denson DD. Cardiovascular toxicity of local anesthetics: an alternative hypothesis. Anesth Analg. 1986 May; 65 (5):444–450. [PubMed] [Google Scholar]
• Morishima HO, Pedersen H, Finster M, Hiraoka H, Tsuji A, Feldman HS, Arthur GR, Covino BG. Bupivacaine toxicity in pregnant and nonpregnant ewes. Anesthesiology. 1985 Aug; 63 (2):134–139. [PubMed] [Google Scholar]
• de Jong RH, Bonin JD. Benzodiazepines protect mice from local anesthetic convulsions and deaths. Anesth Analg. 1981 Jun; 60 (6):385–389. [PubMed] [Google Scholar]
• Gregg RV, Turner PA, Denson DD, Stuebing RC, Sehlhorst CS, Forsberg T. Does diazepam really reduce the cardiotoxic effects of intravenous bupivacaine? Anesth Analg. 1988 Jan; 67 (1):9–14. [PubMed] [Google Scholar]
• Lund PC, Cwik JC, Pagdanganan RT. Etidocaine--a new long-acting anesthetic agent: a clinical evaluation. Anesth Analg. 1973 May-Jun; 52 (3):482–494. [PubMed] [Google Scholar]
• Adams HJ, Kronberg GH, Takman BH. Local anesthetic activity and acute toxicity of ( )-2-(N-ethylpropylamino)-2',6'-butyroxylidide, a new long-acting agent. J Pharm Sci. 1972 Nov; 61 (11):1829–1831. [PubMed] [Google Scholar]
• Laskin JL. Use of etidocaine hydrochloride in oral surgery: a clinical study. J Oral Surg. 1978 Nov; 36 (11):863–865. [PubMed] [Google Scholar]
• Davis WM, Jr, Oakley J, Smith E. Comparison of the effectiveness of etidocaine and lidocaine as local anesthetic agents during oral surgery. Anesth Prog. 1984 Jul-Aug; 31 (4):159–164. [PMC free article] [PubMed] [Google Scholar]
• Donoghue R, Doberenz K, Jacobsen PL. Etidocaine hydrochloride in surgical procedures: effects on postoperative analgesia. J Am Dent Assoc. 1990 Apr; 120 (4):429–434. [PubMed] [Google Scholar]
• Sisk AL, Dionne RA, Wirdzek PR. Evaluation of etidocaine hydrochloride for local anesthesia and postoperative pain control in oral surgery. J Oral Maxillofac Surg. 1984 Feb; 42 (2):84–88. [PubMed] [Google Scholar]
• Giovannitti JA, Bennett CR. The effectiveness of 1.5% etidocaine HCl with epinephrine 1:200,000 and 2% lidocaine HCl with epinephrine 1:100,000 in oral surgery: a clinical comparison. J Am Dent Assoc. 1983 Oct; 107 (4):616–618. [PubMed] [Google Scholar]
• Crout RJ, Koraido G, Moore PA. A clinical trial of long-acting local anesthetics for periodontal surgery. Anesth Prog. 1990 Jul; 37 (4):194–198. [PMC free article] [PubMed] [Google Scholar]
• Jensen OT, Upton LG, Hayward JR, Sweet RB. Advantages of long-acting local anesthesia using etidocaine hydrochloride. J Oral Surg. 1981 May; 39 (5):350–353. [PubMed] [Google Scholar]
• Hlava GL, Reinhardt RA, Kalkwarf KL. Etidocaine HCl local anesthetic for periodontal flap surgery. J Periodontol. 1984 Jun; 55 (6):364–367. [PubMed] [Google Scholar]
• Sisk AL. Comparison of etidocaine and lidocaine for control of intra- and post-operative bleeding and pain. J Oral Maxillofac Surg. 1986 Jan; 44 (1):16–20. [PubMed] [Google Scholar]
• Lynch C., 3rd Depression of myocardial contractility in vitro by bupivacaine, etidocaine, and lidocaine. Anesth Analg. 1986 Jun; 65 (6):551–559. [PubMed] [Google Scholar]
• Morgan M, Russell WJ. An investigation in man into the relative potency of lignocaine, bupivacaine and etidocaine. Br J Anaesth. 1975 May; 47 (5):586–591. [PubMed] [Google Scholar]
• Hickey R, Hoffman J, Ramamurthy S. A comparison of ropivacaine 0.5% and bupivacaine 0.5% for brachial plexus block. Anesthesiology. 1991 Apr; 74 (4):639–642. [PubMed] [Google Scholar]
• Rosenberg PH, Kyttä J, Alila A. Absorption of bupivacaine, etidocaine, lignocaine and ropivacaine into n-heptane, rat sciatic nerve, and human extradural and subcutaneous fat. Br J Anaesth. 1986 Mar; 58 (3):310–314. [PubMed] [Google Scholar]
• Bader AM, Datta S, Flanagan H, Covino BG. Comparison of bupivacaine- and ropivacaine-induced conduction blockade in the isolated rabbit vagus nerve. Anesth Analg. 1989 Jun; 68 (6):724–727. [PubMed] [Google Scholar]
• Bosnjak ZJ, Turner LA. Halothane, catecholamines, and cardiac conduction: anything new? Anesth Analg. 1991 Jan; 72 (1):1–4. [PubMed] [Google Scholar]
• Rutten AJ, Nancarrow C, Mather LE, Ilsley AH, Runciman WB, Upton RN. Hemodynamic and central nervous system effects of intravenous bolus doses of lidocaine, bupivacaine, and ropivacaine in sheep. Anesth Analg. 1989 Sep; 69 (3):291–299. [PubMed] [Google Scholar]
• Reiz S, Häggmark S, Johansson G, Nath S. Cardiotoxicity of ropivacaine--a new amide local anaesthetic agent. Acta Anaesthesiol Scand. 1989 Feb; 33 (2):93–98. [PubMed] [Google Scholar]
• Lee A, Fagan D, Lamont M, Tucker GT, Halldin M, Scott DB. Disposition kinetics of ropivacaine in humans. Anesth Analg. 1989 Dec; 69 (6):736–738. [PubMed] [Google Scholar]
• Kopacz DJ, Carpenter RL, Mackey DC. Effect of ropivacaine on cutaneous capillary blood flow in pigs. Anesthesiology. 1989 Jul; 71 (1):69–74. [PubMed] [Google Scholar]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology