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J Am Dent Assoc, Vol 130, No 12, 1773-1780. © 1999 American Dental Association

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JADA Continuing Education

Background. ß-adrenoreceptor blockers, or ß-blockers, are drugs commonly prescribed for hypertension, angina and migraine headaches. In a patient taking ß-blocker medication, administration of a local anesthetic containing a vasoconstrictor could result in an adverse interaction.

Methods. The authors conducted a double-blind, randomized, crossover, placebo-controlled study to test the hypothesis that a nonselective ß-blocker—nadolol—enhances vasoconstriction induced by the epinephrine contained in local anesthetic, thus resulting in an increased duration of anesthesia. Ten healthy male volunteers were given either a placebo or a single, standard oral dose of nadolol (80 milligrams). The upper lateral incisor teeth were anesthetized using lidocaine with or without epinephrine.

Results. The mean duration of pulpal and soft-tissue anesthesia was increased in subjects who took nadolol compared with those who took placebo by 17 minutes (58 percent) and 16.5 minutes (19 percent), respectively, when they received 1 milliliter of lidocaine containing 1:100,000 epinephrine. These differences were both clinically and statistically significant (P = .007). Using lidocaine without epinephrine produced no clinically or statistically significant difference in duration of pulpal or soft-tissue anesthesia in the two groups of subjects. The authors noted no significant changes in blood pressure or pulse rate.

Conclusions. Administration of local anesthetic containing epinephrine to subjects receiving a ß-blocker increased the duration of pulpal and soft-tissue anesthesia. There was no difference in duration of anesthesia between groups when local anesthetic without epinephrine was used.

Clinical Implications. Use of local anesthetic containing a vasoconstrictor should be avoided in patients taking ß-blocker medication because of a possible adverse drug interaction. However, when a vasoconstrictor is indicated for hemostasis, the local anesthetic should be administered slowly and in small amounts as pulse rate and blood pressure are being monitored. The patient should be informed that the duration of anesthesia might be prolonged.

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