The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: two controlled clinical trials.
OBJECTIVE
The authors conducted two double-blinded, randomized, multicenter clinical trials to determine the efficacy and clinical anesthetic characteristics of 4 percent articaine hydrochloride (HCl) with 1:200,000 epinephrine (A200) as compared with those of 4 percent articaine HCl with 1:100,000 epinephrine (A100) and 4 percent articaine HCl without epinephrine (Aw/o).


METHODS
During separate testing sessions, members of the authors' research team used three articaine study formulations to induce either inferior alveolar nerve block anesthesia (Trial 1) or maxillary infiltration anesthesia (Trial 2). In each trial, subjects received, in a randomized sequence, each of the three formulations to determine efficacy (success rate) and anesthetic characteristics (onset time and duration). The authors evaluated pulpal anesthesia via subjects' response to electric pulp testing (EPT).


RESULTS
A total of 126 subjects were enrolled in the two studies (63 subjects in each trial). In both mandibular and maxillary trials, the success rates for inducing profound anesthesia (EPT score > 80), the mean onset times and the mean durations of anesthesia were similar for both epinephrine-containing formulations (A200 and A100). In subjects who received the formulation containing no epinephrine (Aw/o), the success rate for profound anesthesia was significantly less.


CONCLUSIONS
These studies demonstrated that the inclusion of epinephrine in 4 percent articaine anesthetic formulations is essential for achieving profound anesthesia. The authors found that the A200 formulation provided a level of pulpal anesthesia comparable with that of the A100 formulation.
Moore
Paul A
PA
Department of Anesthesiology, Oral Health Science Institute, School of Dental Medicine, University of Pittsburgh, 552 Salk Hall, Pittsburgh, PA 15261, USA. pam7@pitt.edu
Boynes
Sean G
SG
Hersh
Elliot V
EV
DeRossi
Scott S
SS
Sollecito
Thomas P
TP
Goodson
J Max
JM
Leonel
Juliana S
JS
Floros
Constantinos
C
Peterson
Carrie
C
Hutcheson
Matthew
M
D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local; D002355:Carticaine; D004347:Drug Interactions; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002355:Carticaine; D004837:Epinephrine