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Local Anesthetic Action of Tramadol Hydrochloride With Adrenaline vs Lidocaine Hydrochloride With Adrenaline for Maxillary Exodontia
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Tramadol hydrochloride (T-HCl) has demonstrated to have a local anesthetic effect similar to lidocaine hydrochloride (L-HCl) when administered locally for minor oral surgical procedures.
PURPOSE
Our study aimed to compare the anesthetic effect of T-HCl versus L-HCl in maxillary premolar extraction.
STUDY DESIGN, SETTING AND SAMPLE
The study is a split-mouth, double-blind randomized clinical trial at the Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India. The study sample was composed of patients referred for maxillary bicuspid extraction. Patients were excluded from the sample if, allergic to the study drugs, pregnant or lactating females, and smokers.
EXPOSURE VARIABLE
The variable is an anesthetic drug administered for local anesthesia and it is grouped into 2 categories, T-HCl and L-HCl. A supraperiosteal infiltration of T-HCl with adrenaline on one side and L-HCl with adrenaline on the contralateral side was injected.
MAIN OUTCOME VARIABLE
The primary outcome variable was profound anesthesia of T-HCl, where the patient sensed the loss of sensation of touch, temperature, and pain. Secondary outcomes were onset and duration of anesthesia, intraoperative pain, postoperative analgesia, and adverse reactions, were recorded.
ANALYSES
Inferential statistics, the χ2 Test, the Mann-Whitney Test, and the Wilcoxon signed-rank test were used to compare the parameters. The level of significance was set at ≤ 0.05.
RESULTS
A total of 40 patients were included, and 80 teeth were extracted. Profound anesthesia was achieved in all the cases. The mean subjective duration of anesthesia in the T-HCl and L-HCl groups was 130.80 ± 20.01 minutes and 111.40 ± 14.87 minutes, respectively, with a P value of .001. The mean Visual Analogue Scale (VAS) score for pain during the procedure in the T-HCl and L-HCl groups was 0.60 ± 0.67 and 1.10 ± 0.71, respectively, with a P value of .002. The mean Visual Analogue Scale score for pain postoperatively in the T-HCl and L-HCl groups was 0.70 ± 0.72 and 1.40 ± 0.67, respectively, with a P value of .001. Six patients in T-HCl required postoperative analgesia when compared to 18 patients in L-HCl (P value < .003).
CONCLUSIONS AND RELEVANCE
T-HCl provides similar anesthetic outcomes in the extraction of maxillary bicuspids as L-HCl.
Additional Info
Disclosure statements are available on the authors' profiles:
Comparative Evaluation of the Local Anesthetic Action of Tramadol Hydrochloride With Adrenaline Versus Lidocaine Hydrochloride With Adrenaline for Maxillary Exodontia: A Randomized Control Trial
J Oral Maxillofac Surg 2024 Apr 01;82(4)478-484, Y Raju Kr, P Sagar, K Prasad, P Shridhar, K RanganathFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
All drugs do many things. A drug is used for what it does best — its "indication." Local anesthetics (LAs) are most effective at transiently blocking nerve conduction (their indication); however, LAs are also capable of producing CNS depression (sedation). Antihistamines (H1-blockers), such as diphenhydramine (Benadryl), primarily indicated for the management of mild allergy, are known to produce sedation as well as possessing antiemetic effects. Diphenhydramine also possesses LA actions, making it an option for pain control in those very rare clinical situations where a patient is unable to tolerate a traditional LA (eg, having a documented allergy to an amide LA). A third example is the opioid analgesic tramadol (Ultram). Its indication is for the short-term management of moderate to severe pain. Tramadol has been demonstrated to possess LA properties similar to those of lidocaine hydrochloride.
Raju et al compared the LA efficacy of 2 mL of 5% tramadol plus 1:200,000 epinephrine (T-HCl) with that of 2 mL of lidocaine plus 1:200,000 epinephrine (L-HCl), administered via buccal and palatal infiltration, in 40 patients requiring bilateral maxillary premolar extraction (N = 80 teeth) for orthodontic purposes.
The results for pain management during tooth extraction demonstrated that T-HCl was as effective as L-HCl in that no patient required the administration of a "rescue" LA due to the failure of the initial injection. There was no statistically significant difference observed in the time to onset of anesthesia (T-HCl, 104.95 seconds; L-HCl, 105.80 seconds). A statistically significant difference was noted in the mean subjective duration of anesthesia (T-HCl, 130.80 minutes; L-HCl, 111.40 minutes; P = .001) as well as in the visual analog scale (VAS) scores for intraoperative pain (T-HCl, 0.60; L-HCl, 1.10; P = .002).
When examining postextraction pain intensity (1 day following the extraction), there were statistically significant advantages of T-HCl compared with those of L-HCl (VAS, 0.70 vs 1.40; P = .001). Furthermore, there was a statistically significant difference in the requirement for a postoperative "rescue" medication (100 mg of aceclofenac [an NSAID and an analog of diclofenac]). A total of 6 patients in the T-HCl group required the rescue medication compared with 18 patients in the L-HCl group (P < .003).
This postextraction finding is of significance primarily due to the fact that the drug being used for pain control during the extraction is an opioid analgesic. Administered via injection at a dose of 100 mg, tramadol would be expected to provide a degree of analgesia postoperatively.
The authors concluded that T-HCl "was comparable to L-HCl in terms of anesthetic efficacy in maxillary premolar extraction. It also demonstrates an additional analgesic effect, which minimizes the need for postextraction analgesics.”
As to the practical utility of tramadol as an LA in dentistry, I harbor some doubts. The authors stated that tramadol “can be used as an alternative LA when conventional LA agents are not feasible." Yes; this is true. However, in a 20-year practice career of a typical non–oral surgeon dentist, it is highly unlikely that such a patient (in whom conventional LA administration is not feasible) would be encountered. In the event that such a patient did appear for dental treatment, referral to an oral and maxillofacial surgeon or the use of a dentist anesthesiologist is suggested. One final note: tramadol, an opioid, is classified as a schedule IV drug, requiring the doctor to maintain a permit from the US DEA.
This very interesting study demonstrates, once again, that all drugs can do many things, some of which have valid clinical implications.