Dexmedetomidine as an additive to local anesthesia in dentistry.

Alicja Stępień; Paweł Stępień; Julia Kornatowska

doi:10.56782/pps.211

Published : 2024-07-24

Vol. 22 No. 3 (2024)

Dexmedetomidine as an additive to local anesthesia in dentistry

Alicja Stępień

Paweł Stępień

Julia Kornatowska

DOI: https://doi.org/10.56782/pps.211

Abstract

Local anesthetics are the most commonly used drugs in the dental office. They enable painless procedures within the oral cavity, bringing benefits for both the patient, who no longer needs to fear the pain, and the dentist, whose comfort and efficiency in work are increased through patient cooperation. Despite the wide availability of local anesthetics, new and better solutions are constantly sought. A recent innovation under investigation is the addition of dexmedetomidine to local anesthetics. Dexmedetomidine is an α2-adrenergic receptor agonist with analgesic, anti-anxiety and sedative effects. It is commonly used in anesthesiology and intensive care for sedating patients in intensive care units, as a co-analgesic, and as an additive to local anesthetics during peripheral and central nerve blocks. Studies conducted on patients undergoing dental extractions show that adding dexmedetomidine to lidocaine, a commonly used local anesthetic, enhances its anesthetic effect. The α2-adrenergic receptor antagonist prolongs the duration of analgesic action and accelerates its onset. Additionally, it reduces postoperative discomfort and speeds up healing. At the same time, no negative impact on general parameters is noted. This makes it a promising substitute for other additives to local anesthetics, such as adrenaline, especially in patients with contraindications to its use.

Keywords:

dexmedetomidine, local anaesthetics, dental pain

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Stępień, A., Stępień, P., & Kornatowska, J. (2024). Dexmedetomidine as an additive to local anesthesia in dentistry. Prospects in Pharmaceutical Sciences, 22(3), 58–61. https://doi.org/10.56782/pps.211

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References

Pasternak, M.; Woroń, J. Rola znieczulenia miejscowego w uśmierzaniu bólu śródzabiegowego w praktyce stomatologicznej. BÓL 2021, 22(1), 24-35. doi:10.5604/01.3001.0014.9018 DOI: https://doi.org/10.5604/01.3001.0014.9018

Afonso, J.; Reis, F. Dexmedetomidine: current role in anesthesia and intensive care. Rev. Bras. Anestesiol. 2012, 62(1), 118-133. DOI:10.1016/S0034-7094(12)70110-1 DOI: https://doi.org/10.1016/S0034-7094(12)70110-1

Gertler, R.; Brown, H.C.; Mitchell, D.H.; Silvius, E.N. Dexmedetomidine: a novel sedative-analgesic agent. Proc. (Bayl. Univ. Med. Cent.). 2001, 14(1), 13-21. doi:10.1080/08998280.2001.11927725

Calasans-Maia, J.A.; Zapata-Sudo, G.; Sudo, R.T. Dexmedetomidine prolongs spinal anaesthesia induced by levobupivacaine 0.5% in guinea-pigs. J. Pharm. Pharmacol. 2005, 57(11), 1415-1420. doi:10.1211/jpp.57.11.0006

Calasans-Maia, J.A.; Zapata-Sudo, G.; Sudo R.T. Dexmedetomidine prolongs spinal anaesthesia induced by levobupivacaine 0.5% in guinea-pigs.

J. Pharm. Pharmacol. 2005, 57(11), 1415-1420. doi:10.1211/jpp.57.11.0006 DOI: https://doi.org/10.1211/jpp.57.11.0006

Brummett, C.M.; Norat, M.A.; Palmisano, J.M.; Lydic, R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008, 109(3), 502-511. doi:10.1097/ALN.0b013e318182c26b DOI: https://doi.org/10.1097/ALN.0b013e318182c26b

Chen, Z.; Liu, Z.; Feng, C.; Jin, Y.; Zhao, X. Dexmedetomidine as an Adjuvant in Peripheral Nerve Block. Drug Des. Devel. Ther. 2023, 17, 1463-1484. doi:10.2147/DDDT.S405294 DOI: https://doi.org/10.2147/DDDT.S405294

Kaur, M.; Singh, P.M. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth. Essays Res. 2011, 5(2), 128-133. doi:10.4103/0259-1162.94750 DOI: https://doi.org/10.4103/0259-1162.94750

Marhofer, D.; Kettner, SC.; Marhofer, P.; Pils, S.; Weber, M.; Zeitlinger, M. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br. J. Anaesth. 2013, 110(3), 438-442. doi:10.1093/bja/aes400 DOI: https://doi.org/10.1093/bja/aes400

Birnbaumer, L.; Abramowitz, J.; Brown, A.M. Receptor-effector coupling by G proteins. Biochim. Biophys. Acta. 1990, 1031(2), 163-224. doi:10.1016/0304-4157(90)90007-y DOI: https://doi.org/10.1016/0304-4157(90)90007-Y

Cotecchia, S.; Kobilka, B.K.; Daniel, K.W. et al. Multiple second messenger pathways of alpha-adrenergic receptor subtypes expressed in eukaryotic cells. J. Biol. Chem. 1990, 265(1), 63-69. DOI: https://doi.org/10.1016/S0021-9258(19)40195-6

Hunter, J.C.; Fontana, D.J.; Hedley, L.R. et al. Assessment of the role of alpha2-adrenoceptor subtypes in the antinociceptive, sedative and hypothermic action of dexmedetomidine in transgenic mice. Br. J. Pharmacol. 1997, 122(7), 1339-1344. doi:10.1038/sj.bjp.0701520 DOI: https://doi.org/10.1038/sj.bjp.0701520

Gertler, R.; Brown, H.C.; Mitchell, D.H.; Silvius, E.N. Dexmedetomidine: a novel sedative-analgesic agent. Proc. (Bayl. Univ. Med. Cent.). 2001, 14(1), 13-21. doi:10.1080/08998280.2001.11927725 DOI: https://doi.org/10.1080/08998280.2001.11927725

Pöpping, D.M.; Elia, N.; Marret, E.; Wenk, M.; Tramèr, M.R. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology. 2009, 111(2), 406-415. doi:10.1097/ALN.0b013e3181aae897 DOI: https://doi.org/10.1097/ALN.0b013e3181aae897

Eisenach, J.C.; De Kock, M.; Klimscha, W. alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology. 1996, 85(3), 655-674. doi:10.1097/00000542-199609000-00026 DOI: https://doi.org/10.1097/00000542-199609000-00026

Krishnamurthy, B.K.; Aparna, B.; Chikkegowda, S.; Kumar, K.S.L. Comparison between Dexmedetomidine and Clonidine as an Adjuvant to Ropivacaine in Ultrasound-Guided Adductor Canal Block for Postoperative Analgesia in Total Knee Replacement: A Randomized Controlled Trial. Anesth. Essays. Res. 2021, 15(2), 245-249. doi:10.4103/aer.aer_143_21 DOI: https://doi.org/10.4103/aer.aer_143_21

Brummett, C.M.; Hong, E.K.; Janda, A.M.; Amodeo, F.S.; Lydic, R. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current. Anesthesiology. 2011, 115(4), 836-843. doi:10.1097/ALN.0b013e318221fcc9 DOI: https://doi.org/10.1097/ALN.0b013e318221fcc9

Kroin, J.S.; Buvanendran, A.; Beck, D.R.; Topic, J.E.; Watts, D.E.; Tuman, K.J. Clonidine prolongation of lidocaine analgesia after sciatic nerve block in rats Is mediated via the hyperpolarization-activated cation current, not by alpha-adrenoreceptors. Anesthesiology. 2004, 101(2), 488-494. doi:10.1097/00000542-200408000-00031 DOI: https://doi.org/10.1097/00000542-200408000-00031

Autorstwa Fvasconcellos https://commons.wikimedia.org/w/index.php?curid=3893825 (dostęp: 24.05.2024)

Alizargar, J.; Etemadi Sh. M.; Kaviani, N. et al. Injection of Lidocaine Alone versus Lidocaine plus Dexmedetomidine in Impacted Third Molar Extraction Surgery, a Double-Blind Randomized Control Trial for Postoperative Pain Evaluation. Pain. Res. Manag. 2021, 2021, 6623792. doi:10.1155/2021/6623792 DOI: https://doi.org/10.1155/2021/6623792

Suryawanshi, T.; Jadhav, A.; Gupta, A.; Agrawal, P.; Sharma, A. Comparative Analysis of Anaesthetic Efficacy of 2% Lignocaine With Dexmedetomidine as an Adjunct in Nerve Blocks for Dental Extractions: A Randomised Controlled Study. Cureus. 2022, 14(9), e28867. doi:10.7759/cureus.28867 DOI: https://doi.org/10.7759/cureus.28867

Nalawade, S.H.; Nilesh, K.; Kumar, C.D.M.; Punde, P.A.; Patil, P.B. A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars. Natl. J. Maxillofac. Surg. 2021, 12(2), 255-261. doi:10.4103/njms.NJMS_7_20 DOI: https://doi.org/10.4103/njms.NJMS_7_20

Yoshitomi, T.; Kohjitani, A.; Maeda, S.; Higuchi, H.; Shimada, M.; Miyawaki, T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth. Analg. 2008, 107(1), 96-101. doi:10.1213/ane.0b013e318176be73 DOI: https://doi.org/10.1213/ane.0b013e318176be73

Venn, R.M.; Bradshaw, C.J.; Spencer, R. et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999, 54(12), 1136-1142. doi:10.1046/j.1365-2044.1999.01114.x DOI: https://doi.org/10.1046/j.1365-2044.1999.01114.x

Dexmedetomidine Accord, INN-dexmedetomidine https://ec.europa.eu/health/documents/community-register/2020/20200213147056/anx_147056_pl.pdf (dostęp: 02.06.2024)

Charakterystyka-40598-2023-04-19-15665_B-2023-11-01 https://rejestry.ezdrowie.gov.pl/api/rpl/medicinal-products/40598/characteristic (dostęp: 02.06.2024) DOI: https://doi.org/10.58372/2835-6276.1092

Charakterystyka-44231-2022-10-19-12163_B-2022-11-10 https://rejestry.ezdrowie.gov.pl/api/rpl/medicinal-products/44231/characteristic (dostęp: 02.06.2024)

Charakterystyka-39205-20200327000000-8128_B-20200501000237 https://rejestry.ezdrowie.gov.pl/api/rpl/medicinal-products/39205/characteristic (dostęp: 02.06.2024)

Charakterystyka-40214-2023-03-30-15666_B-2023-11-01 https://rejestry.ezdrowie.gov.pl/api/rpl/medicinal-products/40214/characteristic (dostęp: 02.06.2024)

Alicja Stępień

alicjahaberka5@gmail.com

Affiliation:

a:1:{s:5:"en_US";s:31:"Warszawski Uniwersytet Medyczny";} Poland

Paweł Stępień

Affiliation:

Department of Anesthesiology and Intensive Care, Upper-Silesian Medical Centre of the Medical University of Silesia, 40-635 Katowice, Poland Poland

Julia Kornatowska

Affiliation:

Gordent Dental Clinic, 02-784 Warsaw, Poland Poland