Cardiovascular effects of combined hyaluronidase and mepivacaine in dental anesthesia: A randomized clinical trial

Abstract

Purpose: To evaluate the effects of combined administration of mepivacaine with epinephrine and the diffusion agent hyaluronidase on hemodynamic and electrocardiographic parameters in healthy individuals undergoing dental surgery. Methods: In a double-blind, split-mouth, randomized clinical trial, the cardiovascular effects induced by 2.7 mL of 2% mepivacaine with 1:100,000 epinephrine injected concomitantly with 1 mL of 75 TRU/mL hyaluronidase or placebo for inferior alveolar nerve block was evaluated in systemically healthy subjects that underwent bilateral third molar extraction in two separate sessions. Systolic and diastolic blood pressure and heart rate were monitored using oscillometric and photoplethysmographic methods in 10 clinical stages, while electrocardiographic records of 12 leads were obtained in four stages. Results: Hyaluronidase injected concomitantly with local anesthetic did not induce changes in blood pressure and heart rate compared to placebo. There were no instances of ST segment depression or elevation, or wide or narrow QRS complex extrasystoles in ECG. The use of mepivacaine injected concomitantly with 75 TRU/mL hyaluronidase was safe, from a cardiovascular standpoint.