Objective: The hyaluronidase is an enzyme that has been employed in ophthalmology to improve the effectiveness of anesthesia and to avoid supplementary anesthesia. It cleaves reversibly the hyaluronic acid of the extracellular matrix in the connective tissues. There is the assumption that it could be a future alternative of adjuvant to local anesthetic to systemically compromised patients with restriction of maximum dose of anesthetic or adrenergic vasoconstrictor. However, the hyaluronidase can increase the diffusion of local anaesthetic to the the nervous fibers and to the blood circulation as well, which could induce changes in the cardiovascular dynamic. The purposes of this controlled
, double-blind, splint mouth and
randomized partially trial were to evaluate the cardiovascular effects induced by alveolar inferior nerve block of local anesthetic (LA) 2% mepivacaine with epinephrine (1: 100,000), injected concomitantly to hyaluronidase 75 TRU/ml or placebo, during symmetric bilateral lower third molar surgery in 20 ASA I outpatients. The interval between the surgeries was at least fifteen days.
Method: The cardiovascular parameters systolic (SP), diastolic (DP) and mean (MP) pressures and heart rate (HR) were monitored by oscillometric and photopletismographic methods respectively in 8 clinical steps of the procedure T(-5´), T (LA + H or PL), T(5´), T(Incision), T(syndesmotomy), T(shifted tooth), T(avulsion), T(curettage), T(suture) and T(rest).
Result: The hyaluronidase injected concomitantly to the LA did not induce significant cardiovascular changes (p>0.01, ANOVA) comparing to placebo. The mean values of the variables did not differ significantly among the clinical steps.
Conclusion: The use of hyaluronidase injected concomitantly to local anesthetic shows to be safe for this dose and way of administration.