Rigshospitalet and Dental School, University of Copenhagen, Denmark.
J Am Dent Assoc. 2011 May;142(5):531-9. doi: 10.14219/jada.archive.2011.0223.
The authors used comprehensive national registry and clinical data to conduct a study of adverse drug reactions (ADRs), in particular neurosensory disturbance (NSD), associated with local anesthetics used in dentistry
The study included data sets of annual sales of local anesthetics (from 1995 through 2007), 292 reports to the Danish Medicines Agency, Copenhagen, Denmark, of adverse reactions to local anesthetic drugs, and a clinical sample of 115 patients with NSD associated with local anesthetics. The authors assessed lidocaine 2 percent, mepivacaine 2 percent and 3 percent, prilocaine 3 percent, and articaine 4 percent sold in cartridges.
The study results showed a highly significant overrepresentation of NSDs associated with articaine 4 percent, in particular with mandibular blocks.
The distribution of NSDs was disproportionate to the market share of three of the four drugs in both national registry data and clinical data. These findings indicate that the main cause of injury was neurotoxicity resulting from administration of the local anesthetic rather than the needle penetration.
Clinicians may consider avoiding use of high-concentration (4 percent) anesthetic formulations for block anesthesia in the trigeminal area in cases in which there are viable alternatives.
作者使用综合国家注册和临床数据，对牙科局部麻醉剂相关的药物不良反应（ADR），特别是神经感觉障碍（NSD）进行了研究。
该研究包括局部麻醉剂年销售量数据集（1995 年至 2007 年）、哥本哈根丹麦药品管理局收到的 292 份局部麻醉药不良反应报告，以及与局部麻醉剂相关的 115 例 NSD 临床样本。作者评估了 2%利多卡因、2%和 3%甲哌卡因、3%丙胺卡因和 4%阿替卡因在管中的销售情况。
研究结果表明，与articaine 4%相关的 NSDs 显著增加，尤其是在下颌阻滞时。
在国家登记数据和临床数据中，NSD 的分布与四种药物中的三种的市场份额不成比例。这些发现表明，损伤的主要原因是局部麻醉剂给药引起的神经毒性，而不是针穿透。
在可行的替代方案存在的情况下，临床医生在三叉神经区域进行阻滞麻醉时可能会考虑避免使用高浓度（4%）的麻醉制剂。
