No

Local Anesthetic

Dental: Amide-type anesthetic used for local infiltration anesthesia; injection near nerve trunks to produce nerve block

C

Hypersensitivity to local anesthetics of the amide-type

Should be avoided in patients with uncontrolled hyperthyroidism. Should be used in minimal amounts in patients with significant cardiovascular problems (because of epinephrine component). Aspirate the syringe after tissue penetration and before injection to minimize chance of direct vascular injection

Degree of adverse effects in the CNS and cardiovascular system are directly related to the blood levels of prilocaine. The effects below are more likely to occur after systemic administration rather than infiltration.

Central nervous system: High blood levels result in anxiety, restlessness, disorientation, confusion, dizziness, tremors and seizures. This is followed by depression of CNS resulting in somnolence, unconsciousness and possible respiratory arrest. Nausea and vomiting may also occur. In some cases, symptoms of CNS stimulation may be absent and the primary CNS effects are somnolence and unconsciousness.

Hypersensitivity reactions: Extremely rare, but may be manifest as dermatologic reactions and edema at injection site. Asthmatic syndromes have occurred. Patients may exhibit hypersensitivity to bisulfites contained in local anesthetic solution to prevent oxidation of epinephrine. In general, patients reacting to bisulfites have a history of asthma and their airways are hyper-reactive to asthmatic syndrome.

Psychogenic reactions: It is common to misinterpret psychogenic responses to local anesthetic injection as an allergic reaction. Intraoral injections are perceived by many patients as a stressful procedure in dentistry. Common symptoms to this stress are sweating, palpitations, hyperventilation, generalized pallor, and a fainting feeling.

Due to epinephrine component, use with tricyclic antidepressants or MAO inhibitors could result in increased pressor response; use with nonselective beta-blockers (ie, propranolol) could result in serious hypertension and reflex bradycardia

Local anesthetics bind selectively to the intracellular surface of sodium channels to block influx of sodium into the axon. As a result, depolarization necessary for action potential propagation and subsequent nerve function is prevented. The block at the sodium channel is reversible. When drug diffuses away from the axon, sodium channel function is restored and nerve propagation returns.

Onset of action:

Infiltration <2 minutes

Inferior alveolar nerve block: <3 minutes

Duration:

Infiltration 2.25 hours

Inferior alveolar nerve block: 3 hours

Children <10 years: Doses >40 mg (1 mL) of prilocaine hydrochloride as a 4% solution with epinephrine 1:200,000 are rarely needed

Children >10 years and Adults: Dental anesthesia, infiltration, or conduction block: Initial: 40-80 mg (1-2 mL) of prilocaine hydrochloride as a 4% solution with epinephrine 1:200,000; up to a maximum of 400 mg (10 mL) of prilocaine hydrochloride within a 2-hour period. The effective anesthetic dose varies with procedure, intensity of anesthesia needed, duration of anesthesia required, and physical condition of the patient. Always use the lowest effective dose along with careful aspiration.

The following numbers of dental carpules (1.8 mL) provide the indicated amounts of prilocaine hydrochloride 4% and epinephrine 1:200,000.

1 cartridge: 72 mg prilocaine 4% and 0.009 mg vasoconstrictor (epinephrine 1:200,000)

2 cartridges: 144 mg prilocaine 4% and 0.018 mg vasoconstrictor (epinephrine 1:200,000)

3 cartridges: 216 mg prilocaine 4% and 0.027 mg vasoconstrictor (epinephrine 1:200,000)

4 cartridges: 288 mg prilocaine 4% and 0.036 mg vasoconstrictor (epinephrine 1:200,000)

5 cartridges: 360 mg prilocaine 4% and 0.045 mg vasoconstrictor (epinephrine 1:200,000)

6 cartridges: 432 mg prilocaine 4% and 0.054 mg vasoconstrictor (epinephrine 1:200,000)

7 cartridges: 504 mg prilocaine 4% and 0.063 mg vasoconstrictor (epinephrine 1:200,000)

8 cartridges: 576 mg prilocaine 4% and 0.072 mg vasoconstrictor (epinephrine 1:200,000)

Note: Adult and children doses of prilocaine hydrochloride with epinephrine cited from USP Dispensing Information (USP DI), 17th ed, The United States Pharmacopeial Convention, Inc, Rockville, MD, 1997, 140.

No data reported

No information available to require special precautions

No effects or complications reported

Injection: Prilocaine hydrochloride 4% with epinephrine 1:200,000 (1.8 mL cartridges, in boxes of 100)

Ayoub ST and Coleman AE, "A Review of Local Anesthetics," Gen Dent, 1992, 40(4):285-7, 289-90.

Blanton PL and Roda RS, "The Anatomy of Local Anesthesia," J Calif Dent Assoc, 1995, 23(4):55-65.

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

MacKenzie TA and Young ER, "Local Anesthetic Update," Anesth Prog, 1993, 40(2):29-34.

Wynn RL, "Epinephrine Interactions With Beta-Blockers," Gen Dent, 1994, 42(1):16, 18.

Yagiela JA, "Local Anesthetics," Anesth Prog, 1991, 38(4-5):128-41.

Yagiela JA, "Vasoconstrictor Agents for Local Anesthesia," Anesth Prog, 1995, 42(3-4):116-20.