Comparative Analysis of Local Anaesthesia with Two Different Concentrations of Adrenaline in Mandibular Third Molar Extraction: A Quasi-Experimental Study : Local Anaesthesia with 2 Concentrations of Adrenaline in Mandibular Third Molar Extraction

Muhammad Mohsin Khan; Muhammad Ilyas; Arham Abid Jamil; Hadiqa Noor; Saif Aslam Khan; Shah Hussain; Dur E Shewar Rehman

doi:10.54393/pjhs.v7i9.3910

Authors

Muhammad Mohsin Khan Department of Oral and Maxillofacial Surgery, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Muhammad Ilyas Department of Oral and Maxillofacial Surgery, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Arham Abid Jamil Department of Oral and Maxillofacial Surgery, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Hadiqa Noor Department of Oral and Maxillofacial Surgery, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Saif Aslam Khan Department of Oral and Maxillofacial Surgery, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Shah Hussain Department of Oral and Maxillofacial Surgery, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Dur E Shewar Rehman Department of Basic Sciences, King Saud bin Abdulaziz University, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.54393/pjhs.v7i9.3910

Keywords:

Adrenaline, Inferior Alveolar Nerve Block, 2% Lignocaine, Local Anesthesia, Third Molar Extraction

Abstract

Local anaesthesia is often used in dental procedures to eliminate pain during procedures. Lignocaine mixed with adrenaline is popular because it extends the time of anaesthesia and reduces the drug's absorption into the bloodstream, thus decreasing the risk of toxicity. Objective: To assess the efficacy and cardiovascular effects of a two-per-cent lidocaine solution containing two concentrations of adrenaline, 1:80000 and 1:100000, during the extraction of mandibular third molars. Methodos: A quasi-experimental study was conducted on 50 patients selected for bilateral mandibular third molar surgery. The patients’ sites were equally divided into two groups: Group 1-2% lignocaine with adrenaline concentration of 1:80,000, and Group 2 – 2% lignocaine with adrenaline concentration of 1:100,000. The study recorded the onset and duration of anesthesia, pulse rate, blood pressure, and pain intensity, which was assessed using the Visual Analog Scale (VAS). Data were compiled and analyzed using SPSS version 26. Results: Group 1 (1:80,000) had a longer duration of anesthesia (149.79 ± 18.05 min) than Group 2 (116.82 ± 12.74 min, p=0.001). Time of onset showed minor differences; VAS pain scores were slightly higher in Group 1 (3.5 ± 1.12) than in Group 2 (2.5 ± 1.12, p=0.100). Cardiovascular parameters showed no significant changes. Time of onset showed minor differences. Conclusions: Local anaesthesia with 1:80,000 adrenaline provided a longer duration of anaesthesia compared to 1:100,000 adrenaline, with comparable onset times and pain scores. Both concentrations provide effective anesthesia. 1:100,000 adrenaline is safer for patients with cardiovascular risk.

References

Camps-Font O, Figueiredo R, Sánchez-Torres A, Clé-Ovejero A, Coulthard P, Gay-Escoda C et al. Which is the Most Suitable Local Anaesthetic When Inferior Nerve Blocks Are Used for Impacted Mandibular Third Molar Extraction? A Network Meta-Analysis. International Journal of Oral and Maxillofacial Surgery. 2020 Nov; 49(11): 1497-507. doi: 10.1016/j.ijom.2020.04.016. DOI: https://doi.org/10.1016/j.ijom.2020.04.016

Doshi A, Bhola N, Agarwal A. Comparing the Efficacy of Adrenaline, Clonidine, and Dexmedetomidine in Enhancing Local Anesthesia for Impacted Third Molar Extraction: A Randomized Controlled Trial. Journal of Dental Anesthesia and Pain Medicine. 2024 Jul; 24(4): 285. doi: 10.17245/jdapm.2024.24.4.285. DOI: https://doi.org/10.17245/jdapm.2024.24.4.285

Ahmed A, Qurishi A, Al-Qahtani M, Al-Harthi M, Khan S. Comparing the Local Anaesthetic Efficacy During the Extraction of Impacted Mandibular Third Molars: A Randomized Prospective Study. Bulletin of Stomatology and Maxillofacial Surgery. 2025; 21(10): 408-414. doi: 10.58240/1829006X-2025.21.10-408. DOI: https://doi.org/10.58240/1829006X-2025.21.10-408

Soman H, Senthil Kumar MS, Nanda Kumar TR, Radhakrishnan K, Loganathan D, Nazir Kaul R. Does the Effect of Adrenaline on Intraoral 2% Lidocaine Contribute to Hemodynamic Instability? A Prospective, Randomized Double Blinded Study. Oral Surgery. 2021 Nov; 14(4): 342-8. doi: 10.1111/ors.12637. DOI: https://doi.org/10.1111/ors.12637

England LJ, Syms III CA, York C. Pharmacokinetics of Single Dose Lidocaine and Epinephrine Following Iontophoresis of the Tympanic Membrane in a Double-Blinded Randomized Trial. Otology and Neurotology. 2021 Apr; 42(7): 1095. doi: 10.1097/MAO.0000000000003128. DOI: https://doi.org/10.1097/MAO.0000000000003128

Poorna P, Shetty P, Kalyani V, Shetty S, Upadya M, Mithra P. A Comparative Evaluation of the Effect of Addition of 8 Mg Dexamethasone To 2% Lignocaine with Adrenaline in Mandibular Third Molar Surgery: A Split Mouth Randomized Double Blind Study. Frontiers in Oral Health. 2024 Feb; 5: 1349832. doi: 10.3389/froh.2024.1349832. DOI: https://doi.org/10.3389/froh.2024.1349832

Priyaranjan, Rohit, Dcruz TM, Patel C, Masih A, Shaik I. A Comparative Study Evaluating the Efficacy of Lignocaine and Dexmedetomidine with Lignocaine and Adrenaline in Third Molar Surgery. Journal of Maxillofacial and Oral Surgery. 2022 Jun; 21(2): 634-8. doi: 10.1007/s12663-020-01477-x. DOI: https://doi.org/10.1007/s12663-020-01477-x

Rossi MT, de Oliveira MN, Vidigal MT, de Andrade Vieira W, Figueiredo CE, Blumenberg C et al. Effectiveness of Anesthetic Solutions For Pain Control In Lower Third Molar Extraction Surgeries: A Systematic Review Of Randomized Clinical Trials With Network Meta-Analysis. Clinical Oral Investigations. 2021 Jan; 25(1): 1-22. doi: 10.1007/s00784-020-03675-w. DOI: https://doi.org/10.1007/s00784-020-03675-w

Vishal G, Dandriyal R, Singh HP, Chaurasia A. Comparative Study of the Anaesthetic Efficacy of 4% Articaine Versus 2% Lidocaine with Adrenaline During Extraction of Mandibular Molars Using an Inferior Alveolar Nerve Blocking Technique. British Journal of Oral and Maxillofacial Surgery. 2021 Sep; 59(7): 783-7. doi: 10.1016/j.bjoms.2020.09.017. DOI: https://doi.org/10.1016/j.bjoms.2020.09.017

Yang F, Gao Y, Zhang L, Zheng B, Wang L, Sun H, Huang D. Local Anaesthesia for Surgical Extraction of Mandibular Third Molars: A Systematic Review and Network Meta-Analysis. Clinical Oral Investigations. 2020 Nov; 24(11): 3781-800. doi: 10.1007/s00784-020-03490-3. DOI: https://doi.org/10.1007/s00784-020-03490-3

Managutti A, Prakasam M, Puthanakar N, Menat S, Shah D, Patel H. Comparative Analysis of Local Anesthesia with 2 Different Concentrations of Adrenaline: A Randomized And Single Blind Study. Journal of International Oral Health. 2015 Mar; 7(3): 24.

Wakita R, Ito T, Fukayama H. Small Doses of Adrenaline Contained in the Local Anaesthetic May Result in Prolonged Increased Cardiac Function Even After the Vital Signs Return to Normal. Advances in Oral and Maxillofacial Surgery. 2021 Jul; 3: 100104. doi: 10.1016/j.adoms.2021.100104. DOI: https://doi.org/10.1016/j.adoms.2021.100104

Veeramuthu M, Karthikeyan M, Balagugan B, Karthikeyan GR, Deepak V, Mathan Mohan A. Evaluating the Efficacy of Local Anaesthetic Solution with Lignocaine and Adrenaline Concentration of 1: 80000 and 1: 200000 in Surgical Removal of Mandibular Third Molar–A Comparative Study. Bull. Env. Pharmacol. Life Sci. 2022 Mar; 11: 186-9.

Kumar S, Goyal R, Arora S, Kusum K. Assessment of Efficacy of Local Anesthesia with 2 Different Concentrations of Adrenaline in Patients Undergoing Mandibular Third Molar Extraction. International Journal of Applied Dental Sciences. 2022; 8(1): 145-147. doi: 10.22271/oral.2022.v8.i1c.1420. DOI: https://doi.org/10.22271/oral.2022.v8.i1c.1420

Mohan AR, Menon S, Sham ME, Archana S, Mathews S, Narayan T. Comparison of Efficacy of 0.5% Ropivacaine Versus 2% Lignocaine Hydrochloride with Adrenaline (1: 80,000) in Surgical Removal of Impacted Mandibular Third Molars with Emphasis on Depth of Anesthesia-Prospective, Randomized, Split Mouth Study. Journal of Maxillofacial and Oral Surgery. 2025 Oct; 24(5): 1481-9. doi: 10.1007/s12663-024-02367-2. DOI: https://doi.org/10.1007/s12663-024-02367-2

Guimaraes CC, Lopes LC, Bergamaschi CD, Ramacciato JC, Silva MT, Araujo JD et al. Local Anaesthetics Combined with Vasoconstrictors in Patients with Cardiovascular Disease Undergoing Dental Procedures: Systematic Review and Meta-Analysis. British Medical Journal Open. 2021 Jul; 11(7): e044357. doi: 10.1136/bmjopen-2020-044357. DOI: https://doi.org/10.1136/bmjopen-2020-044357

Venkateshwar G, Nayan S, Patil TR, Madiwale G, Dahiya S, Nair A. Comparison of Cardiovascular Changes Seen in Patients When Using Local Anesthesia with Adrenalin 1: 80,000 bs Local Anesthesia with Adrenalin 1: 2, 00,000. Journal of Pharmacy and Bioallied Sciences. 2024 Jul; 16(Suppl 3): S2558-62. doi: 10.4103/jpbs.jpbs_391_24. DOI: https://doi.org/10.4103/jpbs.jpbs_391_24

Kalra G, Makkar S, Menrai N, Kalia V, Suri N, Gupta S. Comparative Evaluation of the Efficacy and Onset of Local Anesthesia Using Buffered 2% Lidocaine with 1: 100,000 Adrenaline, Non-Buffered 2% Lidocaine with 1: 100,000 Adrenaline, Buffered 4% Articaine with 1: 100,000 Adrenaline and Non-Buffered 4% Articaine with 1: 100,000 Adrenaline in Dental Extraction. Journal of Maxillofacial and Oral Surgery. 2024 Oct; 23(5): 1255-60. doi: 10.1007/s12663-023-01945-0. DOI: https://doi.org/10.1007/s12663-023-01945-0

Santos CF, Modena KC, Giglio FP, Sakai VT, Calvo AM, Colombini BL et al. Epinephrine Concentration (1: 100,000 or 1: 200,000) Does Not Affect the Clinical Efficacy of 4% Articaine for Lower Third Molar Removal: A Double-Blind, Randomized, Crossover Study. Journal of Oral and Maxillofacial Surgery. 2007 Dec; 65(12): 2445-52. doi: 10.1016/j.joms.2007.04.020. DOI: https://doi.org/10.1016/j.joms.2007.04.020

Malamed SF, Gagnon S, Leblanc D. Efficacy of Articaine: A New Amide Local Anesthetic. The Journal of the American Dental Association. 2000 May; 131(5): 635-42. doi: 10.14219/jada.archive.2000.0237. DOI: https://doi.org/10.14219/jada.archive.2000.0237

Zhang A, Tang H, Liu S, Ma C, Ma S, Zhao H. Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review. Journal of Oral and Maxillofacial Surgery. 2019 Jan; 77(1): 18-28. doi: 10.1016/j.joms.2018.08.020. DOI: https://doi.org/10.1016/j.joms.2018.08.020