Hemostatic Efficacy of 4%Articaine HCl with 1:200,000 or 1:100,000 epinephrine

Objectives: The objective of this double-blind, randomized, three-center crossover study was to compare the efficacy of 4% articaine HCl with 1:100,000 epinephrine (A100) with that of 4% articaine HCl with 1:200,000 epinephrine (A200) in providing effective local anesthesia, improving visualization of the surgical field and limiting surgical blood loss when used to induce anesthesia for periodontal surgery. Methods: Efficacy variables included anesthesia efficacy, surgeon's ability to visualize the surgical field, and volume of blood loss collected from each surgical site. Results: Forty-two adult subjects (26 males/16 females, mean 46.3+9.7 yrs) diagnosed with moderate to severe periodontal disease, and requiring local anesthesia for matched bilateral (split-mouth) periodontal surgery were enrolled. All patients experienced complete surgical anesthesia with A100 and A200 treatments. Statistically significant differences between the A100 and A200 treatments in the surgeon's rating of ability to visualize the surgical field (ranked as clear 83.33% of the time with A100 and 59.52% of the time with A200; p = 0.008), volume of blood loss (mean of 70.2 mL for A200 and 54.9 mL for A100; p = 0.018) and the surgeon's rating of bleeding (ranked as equal to or less than expected 85.71% of the time with A100 and 71.43% of the time with A200; p = 0.034). Sixteen patients (38.1%) experienced a total of 27 mild or medium adverse events, the most common being post-operative pain (9/27, 33.3%) and swelling (8/27, 29.6%). Six adverse events were rated possibly treatment related. Conclusions: When the 4% articaine HCl with 1:100,000 epinephrine was used, the surgical field was clearer, the amount of blood loss was less, and the surgeons rating of expected blood loss were better when compared to matching surgeries using the 4% articaine HCl with 1:200,000 epinephrine formulation. Supported through a contract from Novocol Pharmaceutical of Canada, Inc.