| dc.description.abstract | Adrenaline bitartrate is the most common vasoconstrictor used to counteract the
vasodilatory properties of amide local anesthetics. Use of adrenaline has certain
contraindications and disadvantages specially in patients with cardiovascular diseases.
It is evident from the literature that there are conflicting opinions about usage of
adrenaline with local anesthetics in dental procedures. Use of many drugs as additives
to local anesthetics has been well documented for regional and spinal nerve blocks in
the medical literature. However, there is dearth of such studies in dentistry and till date,
Lignocaine hydrochloride with Adrenaline bitartrate is considered as the standard
solution for local anesthesia for oro-facial procedures. Surgical extractions of impacted
mandibular third molars, the most common surgical procedure in Oral and
Maxillofacial surgery practice, have been used as a model for various comparative
studies related to administration and evaluation of antibiotics, analgesics, steroids, use
of surgical techniques, drains, suture materials etc
This double blind randomized controlled clinical study was thus designed to
comparatively evaluate effectiveness of Clonidine hydrochloride, Potassium chloride,
Dexamethasone sodium phosphate and Chlorpheniramine maleate Vs Adrenaline
bitartrate, used as additives to 2% lignocaine hydrochloride for surgical extractions of
impacted mandibular third molars in healthy young adults. The evaluation was based
on onset, duration, depth of anesthesia, post-operative pain control, bleeding control
and changes in hemodynamics.
A statistically significant difference was obtained for inter group comparison with
Kruskall Wallis ANOVA for all variables used. Mann Whitney test using pair-wise
comparison showed the effect of each drug pair. It was observed that number of
injections used were maximum for CPM and plain Lig grp and least for Dexa and KCl
grps. The onset was fastest with KCl and slowest for CPM grp. The duration of action
was maximum for Dexa and least for plain Lig grp. Intra-operative pain control was
best with Dexa and least with CPM grp, whereas, post-operative pain control was best
with CPM and least with plain Lig grp. Bleeding control was best with Adr and least
with plain Lig grp. Hemodynamic stability was best seen in Dexa and Clonidine grps
and least with Adr.
Thus, none of the drugs used as a substitute fo adrenaline has completely served the
purpose, however, based on the statistical results, Dexamethasone and Clonidine are
still comparable to Adr for most variables with an added advantage of better stability
in hemodynamic variables. Further studies focusing on pH of the mixtures, shelf life of
the solutions, comparison of drug plasma levels, usage in medically compromised pts,
with other oro-facial block techniques, may be planned. | en_US |
