Comparative Evaluation of Local Anaesthesia with and without Adrenaline on Haemodynamic and Metabolic Responses during Tooth Extraction: A Prospective Study
Aug 2026· Journal of Clinical and Diagnostic Research· 0 citations
TL;DR
LA solutions can elicit systemic metabolic responses, and caution is warranted when using lignocaine containing adrenaline in patients with T2DM patients, and Clinicians should consider plain LA alternatives for diabetic patients when prolonged anaesthesia or enhanced haemostasis is not essential.
Abstract
Introduction: Local Anaesthetic (LA) solutions often incorporate vasoconstrictors to delay the systemic absorption of the drug. This prolongs the duration of anaesthesia, reduces toxicity by slowing systemic uptake, lowers the total required dose of LA and enhances anaesthetic efficacy by localising the drug at the injection site. Despite extensive published literature, the systemic metabolic effects of these agents in diabetic dental patients remain underexplored.
Aim: To evaluate the effect of local anaesthesia with and without adrenaline on blood glucose levels and haemodynamic parameters in patients undergoing routine tooth extractions.
Materials and Methods: This prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College, and Hospital, Sangli, Maharashtra, India, from January 2017 to December 2019. The study included 120 patients aged 17 to 65 years requiring multiple tooth extractions, comprising both medically stable non-diabetic individuals and patients with controlled Type 2 Diabetes Mellitus (T2DM) as the primary inclusion criteria. Each participant received two anaesthetic regimens in separate appointments in randomised order. Haemodynamic parameters (systolic and diastolic blood pressure, heart rate) and random blood glucose levels were recorded before injection (R0), immediately after (R1), and at 10 (R2) and 20 minutes (R3) post-injection. Data were analysed using repeated-measures Analysis of Variance (ANOVA) with Bonferroni post-hoc tests for intragroup comparisons, Independent t-tests for intergroup change scores, and Chi-square tests for categorical variables (p≤0.05).
Results: Lignocaine with adrenaline produced significant transient increases in systolic blood pressure, heart rate, and blood glucose levels in diabetic subjects compared with plain lignocaine (p<0.001). Non diabetic patients exhibited smaller, but statistically significant increases in haemodynamic parameters with adrenaline (p<0.05). Blood glucose changes were also statistically significant with adrenaline in non diabetic patients as well (+11.8 mg/dL, p<0.001), although less pronounced than in diabetic subjects. Diastolic blood pressure showed statistically significant but clinically modest increases with adrenaline in both groups (p<0.001), whereas plain lignocaine produced minimal diastolic pressure.
Conclusion: LA solutions can elicit systemic metabolic responses, and caution is warranted when using lignocaine containing adrenaline in patients with T2DM patients. Clinicians should consider plain LA alternatives for diabetic patients when prolonged anaesthesia or enhanced haemostasis is not essential. Patient specific risk assessment is recommended preoperatively, particularly for those with suboptimal glycaemic control despite HbA1c ≤7%. Future studies should evaluate longer term impact on glycaemic control and incorporate non invasive cardiac output monitoring.
Background/Objectives: Local anaesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of dental and oral and maxillofacial surgical local anaesthesia (LA). Three amide agents are commonly used in the UK: lignocaine (lidocaine) 2% with adrenaline 1:80,000; articaine 4% with adrenaline 1:100,000 (2.2 mL cartridges); and bupivacaine 0.5%. Clinically significant discrepancies between guideline sources for maximum recommended dosages (MRDs) persist, and the additive toxicity of combined amide agents remains underappreciated. The objectives are: to provide clear, evidence-appraised MRD guidance for dental practitioners; to explain safe combination dosing using the fractional dose rule with acknowledgement of its pharmacokinetic limitations; and to outline recognition and management of LAST, including intravenous lipid emulsion (ILE) therapy, setting-stratified response, and differential diagnosis. Methods: These include the following: narrative review of MEDLINE (via PubMed), the Cochrane Library, and Embase (inception to May 2026), supplemented by key regulatory documents (British National Formulary (BNF) 91; US Food and Drug Administration (FDA) prescribing information; UK Summaries of Product Characteristics (SmPCs)); major guideline documents (American Society of Regional Anesthesia and Pain Medicine (ASRA) 2018; Association of Anaesthetists 2021; Resuscitation Council UK 2021); systematic reviews; and peer-reviewed literature, ranked by a jurisdiction-specific UK prescribing and regulatory source hierarchy. Results: BNF 91 and the FDA both support a 7 mg/kg (500 mg) MRD for lignocaine with adrenaline; in practice, the adrenaline ceiling limits administration to 6–7 cartridges (2.2 mL) regardless of the guideline followed. The principal reasons for caution when combining amide agents are; additive systemic toxicity, more complex dose calculation, absence of proven clinical benefit for concurrent mixing, unnecessary drug exposure, and incremental hypersensitivity risk—not metabolic pathway differences. The fractional dose rule is a pharmacologically justified safety heuristic with acknowledged pharmacokinetic limitations. ILE is a specific rescue therapy for severe or cardiovascular LAST; airway support and oxygenation remain the primary interventions. Patient-specific factors substantially lower the effective toxic threshold. Conclusions: Safe LA administration in oral surgery requires systematic MRD calculation, application of the fractional dose rule for combined-agent appointments, attention to patient-specific risk factors, setting-appropriate emergency preparedness, and structured differential diagnosis to distinguish LAST from more common dental emergencies.
C. Ucer, Simon Wright, Rabia S. Khan et al.· Dental journal· 0 citations
Background: Tooth extraction under local anesthesia is common in dental practice, and lidocaine/lignocaine with adrenaline is frequently used to improve anesthetic efficacy and hemostasis. However, adrenaline may influence glucose metabolism through adrenergic stimulation, particularly in patients with type II diabetes mellitus.
Objective: To evaluate the acute glycemic response following administration of adrenaline 1:80,000-containing local anesthesia in healthy individuals and patients with type II diabetes mellitus undergoing tooth extraction.
Methods: This comparative analysis included 90 participants divided equally into healthy and diabetic groups. Random blood sugar was assessed before local anesthesia, 5 minutes after local anesthesia, and immediately after extraction. Between-group differences, within-group changes, repeated-measures glycemic response, and adverse events were analyzed.
Results: In the healthy group, mean random blood sugar increased from 110.76 ± 26.82 mg/dL at baseline to 117.00 ± 28.26 mg/dL after local anesthesia and 119.50 ± 27.94 mg/dL after extraction. In the diabetic group, values increased from 161.63 ± 36.87 mg/dL to 171.56 ± 41.48 mg/dL and 175.80 ± 42.84 mg/dL, respectively. The net rise from baseline to post-extraction was greater in diabetic participants than in healthy participants, at 14.17 mg/dL versus 8.74 mg/dL. Repeated-measures analysis showed significant effects of time, group, and time-by-group interaction. Minor adverse events were more frequent in diabetic participants but were not statistically significant. Conclusion: Adrenaline-containing local anesthesia was associated with a measurable but moderate short-term rise in random blood sugar, with a greater response among diabetic participants. Prospective validation using actual patient-level data is required.
Hadiqa Noor, Muhammad Ilyas, Safia Khatoon et al.· Pakistan journal of medicine...· 0 citations
Introduction: Spinal Anaesthesia (SA) is a suitable Regional Anaesthesia (RA) for lower limb surgery, but is limited by its comparatively short analgesic duration. Adjuvants like fentanyl and dexmedetomidine can be administered intrathecally with local anaesthetics like ropivacaine to assist in modulating block parameters, extend the duration of analgesia and decrease systemic administration of opioids.
Aim: To compare and evaluate the safety and efficacy of intrathecal fentanyl and dexmedetomidine as adjuvants to ropivacaine in lower limb orthopaedic surgery.
Materials and Methods: This double-blinded, randomised controlled study was carried out at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. It was performed in 60 American Society of Anaesthesiologists (ASA) I-II patients aged 18-50 years undergoing elective lower limb operations. The patients were divided into two groups: Group-RD was administered 15 mg 0.5% hyperbaric ropivacaine with 10 μg dexmedetomidine and Group-RF was administered 15 mg 0.5% hyperbaric ropivacaine with 20 μg fentanyl. Haemodynamic parameters, sensory and motor block characteristics, sedation {as measured by the Ramsay Sedation Score (RSS)}. Duration of analgesia and sideeffects were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v22.0 and GraphPad Prism v6.0 and p<0.05 was considered statistically significant.
Results: The mean age was 38.43±8.31 years in GroupRF and 37.27±8.75 years in Group-RD. Group-RD showed a significantly earlier onset of sensory block (4.33±0.64 min vs 5.58±0.59 min). Motor block onset was also earlier in Group-RD (5.04±0.75 min) than in Group-RF (7.57±0.60 min), with a longer motor block duration (207.26±6.58 min vs 148.9±8.22 min). Postoperative analgesia lasted significantly longer in Group-RD (391.86±9.89 min) compared with Group-RF (213.3±3.79 min). Haemodynamic parameters remained clinically stable in both groups, with only slight transient decreases in PR and blood pressure and no significant bradycardia or hypotension.
Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine compared to fentanyl in SA. It provides better onset, longer sensory and motor block duration and increased analgesia without inducing further haemodynamic instability or respiratory depression.
Akansha Singhal, Karuna Taksande· Journal of Clinical and Diag...· 0 citations
Background: Spinal anaesthesia is widely employed for elective lower abdominal surgeries because of its rapid onset, reliable sensory blockade, excellent muscle relaxation, and favourable recovery profile. Hyperbaric levobupivacaine is increasingly preferred due to its reduced cardiotoxicity and improved safety profile compared with racemic bupivacaine. Intrathecal fentanyl is commonly used as an adjuvant to enhance block quality and postoperative analgesia. However, limited evidence exists regarding whether sequential administration of hyperbaric levobupivacaine and fentanyl offers advantages over premixed administration in terms of sensory block characteristics, haemodynamic stability, and postoperative analgesia. Methods: This prospective observational comparative study was conducted in the Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chennai, between October 2024 and October 2025. A total of 58 patients aged 18 60 years belonging to ASA physical status I and II and undergoing elective lower abdominal surgeries under spinal anaesthesia were enrolled. Participants were allocated into two groups of 29 patients each. Group S received sequential intrathecal administration of hyperbaric levobupivacaine followed by fentanyl, whereas Group M received a premixed intrathecal solution of the same drugs. Sensory block characteristics, haemodynamic parameters, and postoperative analgesic outcomes were assessed and compared between the groups. Results: Baseline demographic and clinical characteristics were comparable between groups. The onset of sensory block was significantly faster in Group S than in Group M (3.72 ± 0.81 vs. 4.45 ± 0.90 minutes; p=0.003). The duration of sensory blockade was significantly prolonged in Group S, with regression to the L1 dermatome occurring at 103.28 ± 11.98 minutes compared with 91.86 ± 10.95 minutes in Group M (p<0.001). Mean arterial pressure was significantly higher in Group S (83.52 ± 6.21 mmHg) than in Group M (79.90 ± 6.84 mmHg; p=0.031). The incidence of hypotension (17.24% vs. 37.93%) and vasopressor requirement (13.79% vs. 34.48%) were lower in Group S. Postoperative analgesia was significantly superior in Group S, with a longer time to first rescue analgesia (198.52 ± 26.21 vs. 162.48 ± 23.95 minutes; p<0.001) and lower total analgesic consumption (108.97 ± 27.84 vs. 146.21 ± 32.59 mg; p<0.001). Conclusion: Sequential intrathecal administration of hyperbaric levobupivacaine and fentanyl provides faster onset and longer duration of sensory blockade, improved haemodynamic stability, prolonged postoperative analgesia, and reduced analgesic consumption compared with premixed administration. Sequential administration may therefore represent a simple and effective strategy for optimizing spinal anaesthesia in elective lower abdominal surgeries.
D. C, Dr. Rangapriya, Diya Narayanan et al.· Genetics and Molecular Resea...· 0 citations
Both the groups resulted in acceptable, efficient and safe outcomes with no much difference in the brain activity levels, according to the findings of the present study.
N. R. Ghongade, Namrata Gaonkar· Journal of Clinical and Diag...· 0 citations
Introduction: Agents used for induction of anaesthesia often cause vasodilation and suppression of the sympathetic nervous system, leading to a drop in blood pressure. Additionally, laryngoscopy and endotracheal intubation can cause hypertension and tachycardia. So, maintaining haemodynamic stability during induction, intubation and maintenance of anaesthesia is important. Induction of anaesthesia needs sufficient depth of anaesthesia while preventing haemodynamic derangement.
Aim: To study the haemodynamic effects of dexmedetomidine when used as an adjuvant to propofol as compared to propofol as a sole agent in the induction of General Anaesthesia (GA) in patients undergoing elective surgeries under GA.
Materials and Methods: This double-blinded randomised clinical study was conducted at the Department of Anaesthesiology, SUT Academy of Medical Sciences, Trivandrum, Kerala, India, from October 2025 to April 2026. A total of 38 patients were enrolled and randomly assigned to two groups. Group A patients were induced with propofol and vecuronium as muscle relaxants, and in Group B patients were initially given dexmedetomidine before induction with propofol and vecuronium. Heart Rate (HR), Non Invasive Blood Pressure (NIBP) Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Oxygen Saturation (SpO2 ) were recorded in each group at pre op, before induction, one minute, five minutes, 10 minutes and 15 minutes post induction. An Independent t-test was used to compare quantitative parameters, Chi-square test for categorical variables and a Mann-Whitney U Test for comparing ordinal parameters.
Results: A total of 38 patients assessed showed no significant demographic differences. Post induction tachycardia (group A-91.11±5.78; group B-79.00±13.25) was significant in group A. There was significant hypotension (MAP, DBP) post induction in group A {MAP 5 min post induction (group A-84.1±11.0, group B-93.1±9.6), DBP 5 min post induction (group A-70.6±9.8; group B-77.8±10)}. Group A required a significantly higher mean dose of propofol (134.2±25.2 mg) compared to group B (101.1±18.8 mg).
Conclusion: Dexmedetomidine as an adjuvant to propofol provides better haemodynamic stability than propofol alone during induction of GA. The total propofol requirement is also significantly lower in the patients when induced along with Dexmedetomidine.
Jayakrishna Vijayakumar, Tania Jose, Rajan Babu et al.· Journal of Clinical and Diag...· 0 citations