Estudo comparativo da associação da mepivacaína 2% com epinefrina versus mepivacaína 2% com norepinefrina em seres humanos

Abstract

Local anesthetics are the most widely drugs used in dental practice. The present study aimed to report the clinical efficacy and safety of therapeutic Mepivacaine 2% with Epinephrine 1:100,000 (MEPI-E) and Mepivacaine 2% with 1:100,000 norepinephrine (MEPI-N) in infiltration anesthesia of upper canine teeth in healthy volunteers. We conducted a clinical trial, prospective, randomized, crossover, triple blind. Thirty patients were randomly and received either 0.6 ml of both anesthetic solution through terminal infiltrative anesthesia in canines. The degree of pain during anesthetic infiltration was made by visual analog scale of pain (VAE). The induction time was measured by measuring electrical test pulp thus the time required for ensuring the locking. The teeth were subjected to electrical tests in periodic cycles and evaluated by 60 minutes in order to verify the effectiveness of anesthesia in dental tissue. The prick test was used to measure the clinical efficacy in soft tissue, at the following sites: buccal gingiva, upper alveolar mucosa, superior labial mucosa and skin. We also observed vestibular-palatal diffusion of the anesthetic. Systolic and diastolic blood pressure, heart rate, oxygen saturation and blood glucose were used as parameters for assessing the systemic therapeutic safety. Established the significance level of 0.05 (5%) were used GraphPad Prism ® and SPSS ®. Were analyzed a total of 60 punctures anesthetic in 30 study volunteers. The MEPI-N group showed lower levels of pain and discomfort during the anesthetic infiltration, which was statistically significant (P = 0.0106) when compared to the MEPI-E. 86.7% when anesthetized with MEPI-N the electric test were negative a time ≤ 30 seconds, against 43.3% of MEPI group-E (P = 0.002). In evaluating the anesthetic efficacy pulp, statistically significant results were observed in intervals of 40, 50 and 60 minutes of evaluation (P = 0.031, P = 0.021, P = 0.039 respectively) showing greater power to the MEPI-N group, in analyzing the effectiveness anesthesia in the upper lip at 30, 35 and 40 minutes (P = 0.031) showed superiority was also attributed to MEPI-N solution. There was no statistical difference between groups in the analysis under the parameters of therapeutic safety. There was no statistical significance in the intergroup analysis in relation to systemic parameters. Intragroup analysis showed that the systolic and diastolic blood pressure, heart rate were significantly lower than baseline for some time in both groups. The mean glucose at 30 minutes was higher and statistically significant at baseline. Results indicate that anesthetic blocks with 2% Mepivacaine with 1:100,000 norepinephrine are able to provide a better standard anesthetic but without result in systemic changes.