title: Trigeminal nerve injury associated with injection of local anesthetics: needle lesion or neurotoxicity?
abstract: BACKGROUND
  The authors used comprehensive national registry and clinical data to conduct a study of adverse drug reactions (ADRs), in particular neurosensory disturbance (NSD), associated with local anesthetics used in dentistry
  
  
  METHODS
  The study included data sets of annual sales of local anesthetics (from 1995 through 2007), 292 reports to the Danish Medicines Agency, Copenhagen, Denmark, of adverse reactions to local anesthetic drugs, and a clinical sample of 115 patients with NSD associated with local anesthetics. The authors assessed lidocaine 2 percent, mepivacaine 2 percent and 3 percent, prilocaine 3 percent, and articaine 4 percent sold in cartridges.
  
  
  RESULTS
  The study results showed a highly significant overrepresentation of NSDs associated with articaine 4 percent, in particular with mandibular blocks.
  
  
  CONCLUSIONS
  The distribution of NSDs was disproportionate to the market share of three of the four drugs in both national registry data and clinical data. These findings indicate that the main cause of injury was neurotoxicity resulting from administration of the local anesthetic rather than the needle penetration.
  
  
  CONCLUSIONS
  Clinicians may consider avoiding use of high-concentration (4 percent) anesthetic formulations for block anesthesia in the trigeminal area in cases in which there are viable alternatives.
authors.affiliation: Rigshospitalet and Dental School, University of Copenhagen, Denmark. soren@hillerup.net
authors.forename: Søren
authors.initials: S
authors.lastname: Hillerup
authors.forename: Rigmor H
authors.initials: RH
authors.lastname: Jensen
authors.forename: Bjarne K
authors.initials: BK
authors.lastname: Ersbøll
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002355:Carticaine / Q000008:administration & dosage / Q000009:adverse effects; D019992:Databases as Topic; D003718:Denmark; D004172:Diplopia / Q000139:chemically induced / Q000209:etiology; D005157:Facial Pain / Q000139:chemically induced / Q000209:etiology; D005158:Facial Paralysis / Q000139:chemically induced / Q000209:etiology; D005260:Female; D034381:Hearing Loss / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D007267:Injections / Q000009:adverse effects / Q000295:instrumentation; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D009407:Nerve Block / Q000009:adverse effects; D011318:Prilocaine / Q000008:administration & dosage / Q000009:adverse effects; D012678:Sensation Disorders / Q000139:chemically induced / Q000209:etiology; D013651:Taste Disorders / Q000139:chemically induced / Q000209:etiology; D014276:Trigeminal Nerve / Q000187:drug effects; D020433:Trigeminal Nerve Diseases / Q000139:chemically induced* / Q000209:etiology; D061221:Trigeminal Nerve Injuries; D014786:Vision Disorders / Q000139:chemically induced / Q000209:etiology; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D011318:Prilocaine; D008012:Lidocaine; D008619:Mepivacaine; D002355:Carticaine