Assessment of cardiovascular patterns and serum catecholamine concentration in patients undergoing alveolar extraction under local anesthesia with epinephrine: a controlled, blind and randomized clinical trial

OBJECTIVES: A blind, randomized controlled clinical trial was developed to evaluate the cardiovascular effects of local anesthetics with vasoconstrictors (LAVC) containing epinephrine in healthy and hypertensive patients undergoing teeth extraction with lidocaine 2% with epinephrine 1:100.000. MATERIALS AND METHODS: 20 patients were divided into control (CG – normotensive patients) and experimental groups (EG – hypertensive patients). The variables analyzed were heart rate (HR), oxygen saturation (O2S), systolic and diastolic blood pressure (sysBP and diasBP), serum catecholamines concentration (dopamine, epinephrine, and norepinephrine), ventricular and supraventricular extrasystoles (VES and SVES respectively), and ST segment depression. Data was obtained in three different moments (initial, trans and final). Blood samples were taken to measure the catecholamines and a Holter device was used to measure data from the electrocardiogram including a 24-hour postoperative evaluation period. The Mann-Whitney test was used to identify differences between the two groups and the Friedman test with the adjusted Wilcoxon post-test were used for intragroup evaluation for repeated measures. RESULTS: The EG presented a lower O2S in the initial period (p = 0,001) while the sysBP showed a statistical difference for the three evaluation periods with the EG presenting the highest values. The VES where higher for the EG during the 24-hour postoperative evaluation period (p = 0,041). The SVES and the serum catecholamines showed were similar between the groups. The intragroup analysis revealed significant statistical difference for the sysBP in the EG with the trans period presenting the highest measurements. The extrasystoles evaluation showed that the 24-hour postoperative period presented most events with only the CG not presenting statistical difference for the variable VES during this period (p = 0,112). No ST segment depression was noticed for both groups, ie, Myocardial ischemia was not observed. CONCLUSIONS: Teeth extraction with LAVC containing epinephrine can be safely executed in hypertensive patients. Blood pressure should be monitored during the entire procedure, especially in hypertensive patients due to a tendency to high blood pressure within these patients. Serum catecholamines concentration levels are not altered in the conditions seen in this study and the use of LAVC seem not to influence cardiovascular changes in this type of surgery.