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The effects of articaine hydrochloride on wound healing: an experimental study
J Oral Maxillofac Surg 61:1467-1470, 2003
The Effects of Articaine Hydrochloride on Wound Healing: An Experimental Study ¨ ¸cok, DDS,† Cem Korkmaz, MD,‡ Necdet Dog˘an, DDS,* Cahit U ¨ zlem U ¨ ¸cok, DDS,§ and Hakan Alpay Karasu, DDS㛳 O Purpose:
The aim of the study was to examine the effect of articaine hydrochloride (AH) on the healing of surgical wounds and to compare healing with that of lidocaine. Materials and Methods: Forty rats were used in this study. The rats were randomly separated into 4 groups. Three groups were given 2% lidocaine, 4% AH, or injectable saline, and the fourth was a control group. Skin specimens underwent the breaking strength test (BST) and histologic examination at 1 week after the surgical procedure. The skin specimens of the rats were subjected to a pulling force of 10 mm/min across the incision line. The strength value at the moment of breaking in the tissue was expressed in Newtons. Histologic examination was performed as well, and wound healing was graded. Results: Both the histologic grade and BST values in the lidocaine and AH groups were significantly lower than those of the control and saline groups (P ⬍ .01). Similarly, the histologic and BST values of the AH and lidocaine groups were statistically significant (P ⬍ .05, P ⬍ .001). Some necrotic regions were observed at the incision region in 2 samples from the AH group. Conclusion: The results of the study showed that AH is as safe a local anesthetic agent as lidocaine from the standpoint of wound response. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:1467-1470, 2003 The use of local anesthetics is one of the most widely used processes in the practice of dentistry. Various local anesthetic agents are prepared for this purpose. Practices that started with the discovery of cocaine in 1884 continued and became more widespread with the discoveries of procaine in 1904 and lidocaine in 1948.1 Thus, the painless treatment of patients was realized and constituted one of the most important practices of dentistry. Local anesthetics have various effects on the healing of surgical wounds. However, studies aiming at finding safer and more effective local
*Assistant Professor, Department of Oral and Maxillofacial Surgery, Gu ¨ lhane Military Medical Academy, Ankara, Turkey. †Associate Professor, Department of Oral and Maxillofacial Surgery, Dental Faculty, Ankara University, Ankara, Turkey. ‡Chief Resident, Department of Histology, Gu ¨ lhane Military Medical Academy, Ankara, Turkey. §Assistant Professor, Department of Oral Diagnosis and Radiology, Gu ¨ lhane Military Medical Academy, Ankara, Turkey. 㛳Chief Resident, Department of Oral and Maxillofacial Surgery, Dental Faculty, Ankara University, Ankara, Turkey. ¨ c¸ok: Address correspondence and reprint requests to Dr C. U ¨ Ankara Universitesi Dis¸ Hekimlig˘i Faku ¨ ltesi, Bes¸evler, Ankara, Turkey; e-mail: [email protected] © 2003 American Association of Oral and Maxillofacial Surgeons
0278-2391/03/6112-0014$30.00/0 doi:10.1016/j.joms.2003.05.002
anesthetic agents continue. Articaine hydrochloride (AH), a local anesthetic of the amide group, was synthesized and offered for clinical use in 1976 in Germany. The use of AH was initially limited to European countries; however, it was later used in Canada and, after the approval of the Food and Drug Administration, AH began to be used in the United States in April 2000.2 Local anesthetics are known to have modest doserelated effects on wound healing. This experimental study was prepared to examine the effect of AH on the healing of surgical wounds compared with the effect of lidocaine.
Materials and Methods Forty rats (F344) weighing between 230 and 280 g were used in this study. The study was performed in accordance with the protocol prepared with the approval of the Committee for Ethical Experiments on Animals. The rats were kept 7 days before the study in an environment that had good air circulation and heat control, and the animals had free access to water and food. The rats were randomly separated into 4 groups for this experiment. Rats that would receive 2% lidocaine (plus 1:100,000 epinephrine) constituted group 1, those that would receive 4% AH (plus 1:100,000 epinephrine) constituted group 2, those that would receive a saline solution application were group 3,
1467
1468
ARTICAINE HCl AND WOUND HEALING
fixed in the 10% formalin solutions for 2 days. The fixed tissues were blocked by using the routine paraffin method. Then the sections were dyed with Masson’s trichrome stain that dyed collagen as well. The sections were examined under a light microscope. Morphometry was performed in 40 samples by means of a microcomputer analysis system (MCID; System Imaging Research, Ontario, Canada), which allowed quantification of the neoformed collagen fibers in a randomly chosen 100 ⫻ 75 m field for each histologic sample. This examination was prepared according to 4 criteria. FIGURE 1. Microphotograph showing the stage of epithelialization in the articaine group (Masson’s trichrome stain, original magnification ⫻400).
and the control group was group 4. A 4-cm linear incision was prepared on the skin of the dorsal median line of the rats in the control group without any injection. SURGICAL PROCEDURE
All animals were subjected to inhalation anesthesia. Their dorsal regions were shaved and cleaned with povidone-iodine and dried with sterile towels. All surgical processess were performed by the same surgeon, using the same aseptic methods. Solutions of 2.5 mL were injected into 4 separate locations on both sides of the incision line, and a distance of at least 1 cm was kept between these locations and the incision line. On the dorsal median line, a 4-cm linear incision was performed up to the muscular fascia in all samples. Surgical wounds were sutured with nonabsorbable 3-0 silk. No postoperative antibiotic was used. All rats were killed on the seventh day. The tissue specimens, which had a size of 4 ⫻ 8 cm, were dissected from dorsal regions of the rats. The caudal portions of all samples were placed in a 10% formalin solution for further histologic studies. All remaining skin portions were subjected to a breaking determination test.
Stage 1: Stage of Inflammation This is the most early stage of wound healing in tissue. There is edema of tissue, many blood vessels in the form of angioblasts and effective fibroblasts, abundant lymphocytes, and macrophages. Stage 2: Development of Granulation Tissue Edema is reduced. Blood vessel formation is completed, and abundant myofibroblasts are observed in the tissue. The number of lymphocytes and macrophages are decreased. Collagenization starts. Stage 3: Development of Scar Tissue Wound healing is characterized with increased fibroblast and collagen. Epithelialization starts at the edge of the wound (Fig 1). Stage 4: Completion of Epithelialization Wound edges come closer and epithelialization is completed (Fig 2). STATISTICAL ANALYSIS
Collected data were analyzed with the statistical package SPSS 11.0 for Windows (SPSS Inc, Chicago, IL). Groups were compared statistically using the Kruskal-Wallis and Mann-Whitney U tests.
BREAKING STRENGTH TEST
The skin pieces of the rats were placed in the Lloyd LRX (LLOYD LRX, Fareham Hants, England), and a pulling force of 10 mm/min in vertical direction to (across) the incision line was applied. The strength value at the moment of breaking in the tissue was expressed in Newtons (1 N ⫽ 101.97 g). This process was applied to all samples. HISTOLOGIC EXAMINATION
The tissues were transferred into 10% formalin solutions and wound edges were reduced so as to remain in the middle. The reduced tissue samples were
FIGURE 2. Microphotograph showing the stage of epithelialization on lidocaine group (Masson’s trichrome stain, original magnification ⫻200).
1469
˘ AN ET AL DOG
Table 1. DISTRIBUTION OF THE RESULTS OF THE HISTOLOGIC EVALUATION AND BREAKING STRENGTH TEST (BST) FOR THE GROUPS
Histologic Grade Group Control (n ⫽ 10) Saline solution (n ⫽ 10) Lidocaine (n ⫽ 10) Articaine (n ⫽ 10)
Median
Mean (range)
BST (mean ⫾ SD)
4
3.7 (3-4)
12.41 ⫾ 1.45
3
3.4 (3-4)
11.36 ⫾ 1.30
2
2.2 (1-3)*
8.29 ⫾ 1.27*
1
1.5 (1-3)†
5.57 ⫾ 1.22*‡
*Differences between experimental groups with saline and control groups were statistically significant, P ⬍ .01. †Differences between lidocaine and articaine groups were statistically significant, P ⬍ .05. ‡Differences between lidocaine and articaine groups were statistically significant, P ⬍ .001.
Results Complete healing in the incision region was observed on the seventh postoperative day in all samples. Results of the histologic examination and breaking strength test (BST) are shown in Table 1 and Figures 3 and 4. As shown, both histologic grade and BST values in the lidocaine and AH groups were significantly lower than those of the control and saline groups (P ⬍ .01). Similarly, histologic and BST values of the AH and lidocaine groups were statistically significant (P ⬍ .05, P ⬍ .001) (Table 1). Some necrotic regions were observed at the incision region in 2 samples of the AH group.
Discussion Morris and Tracey,3 Eriksson et al,4 and Drucker et al examined the effects of local anesthetic agents on 5
FIGURE 3. Distribution of the results of the histologic evaluation for the groups.
FIGURE 4. Distribution of the results of the breaking strength test for the groups.
the healing of surgical wounds. Some researchers have stated that local anesthetics delay the healing of wounds, whereas others claimed that the same substances had a positive effect on the healing process. Generally, lidocaine was used, and various aspects of the effect of this substance have been observed on the healing of wounds. A particular study focused on whether lidocaine affected the healing of wounds by inhibiting collagen synthesis. To determine the safest dose, various concentrations of lidocaine were used. It was found that although 2% lidocaine substantially reduced the breaking resistance, doses of 0.5% and 1% caused no obvious difference compared with the control group. It was also observed that lidocaine caused local tissue necrosis, and we observed some necrotic regions on 2 samples of the AH group. Morris and Appleby6 focused on the effect of procaine on the healing of wounds. It was determined that doses of 1% and 2% concentrations delayed the healing of wounds and that the use of 1:100,000 epinephrine was a factor that accentuated this effect by allowing procaine to remain longer in the region. Thus, epinephrine injected alone in the region had no negative effect on the healing of wounds. Morris and Tracey3 stated that the injection of sterile water into the wound region also delayed healing of the wound, and they presumed the reason for this to be the fact that the volume of liquid injected into the skin and subcutaneous tissues causes tissue damage. It has been shown that procaine retards the healing of wounds by reducing mucopolysaccharide and, consequently, the collagen synthesis.
1470 Experimental studies have shown that lidocaine and bupivacaine reduced collagen synthesis with a mechanism that affects cell membrane stability and sodium and intracellular calcium movements in rat fibroblast cultures.7,8 Chavapil et al9 determined that local anesthetics inhibited the hydroxylase enzyme, which ensures the binding of hydroxyproline to collagen. Various views were presented, particularly in accordance with the results of studies performed with lidocaine. The dominant claim was that the contradictory results of the studies were due to the use of different experimental animals, the differences between individual immunity types, the solutions used, and the concentrations of vasoconstrictors they included.3,5,6 However, another matter that needs to be taken into account is the fact that the use of local anesthetics in the regions of general surgery compared with oral and maxillofacial surgery requires separate evaluation because of some anatomic and physiologic differences between the application regions. Consequently, if the local anesthetic solution applied onto the skin includes low concentrations of vasoconstrictors, it may have no negative effect on healing of the wound.3 However, local anesthetic solutions can be applied via 2 methods in oral and maxillofacial surgery practices: local infiltration and regional application. It is obvious that a low concentration of vasoconstrictor in the solution will have a negative effect on the work of the surgeon due to possible bleeding in the surgical region more densely in the vessels than the skin (eg, the mouth) and thus will reduce the duration of anesthesia. Oral procedures performed with regional anesthesia are farther away from the local infiltrative application region, so the concentration of the vasoconstrictor/ local anesthetic will not have a negative effect on the healing of wounds. According to this study, it has been observed that both the histologic and BST results were the best in the control group. This has been an expected result
ARTICAINE HCl AND WOUND HEALING
because various studies also reveal that local anesthetic agents cause a delay in wound healing. According to the evaluation of the histologic and BST results, there has been a statistical difference in favor of lidocaine. However, our opinion is that this has no clinical importance. Both agents are routinely used in our country and our clinical experience proves these results. Due to its high anesthetic effectiveness and low complications compared with other anesthetic agents, AH has been widely used by dentists in recent years.1,2 Its effect is not known on the soft tissue of the mouth in oral surgery or on the healing of wounds from skin incisions in maxillofacial surgery but no clinically significant effect is noted. The BST and histologic effects at 7 days cannot imply any clinically relevant delayed wound healing. In light of the results of this study, AH can be regarded as a safe local anesthetic agent for surgery in the head and neck regions.
References 1. Malamed SF, Gagnon S, Leblanc D: Efficacy of articaine: A new amide local anesthetic. J Am Dent Assoc 131:635, 2000 2. Malamed SF, Gagnon S, Leblanc D: Articaine hydrochloride: A study of the safety of a new amide local anesthetic. J Am Dent Assoc 132:177, 2001 3. Morris T, Tracey J: Lignocaine: Its effects on wound healing. Br J Surg 64:902, 1977 4. Eriksson AS, Sinclair R, Cassuto J, et al: Influence of lidocaine on leukocyte function in the surgical wound. Anesthesiology 77:74, 1992 5. Drucker M, Cardenas E, Aritzi P, et al: Experimental studies on the effect of lidocaine on wound healing. World J Surg 22:394, 1998 6. Morris T, Appleby R: Retardation of wound healing by procaine. Br J Surg 67:391, 1980 7. Feinstein MB, Fiekers J, Fraser C: An analysis of the mechanism of local anesthetic inhibition of platelet aggregation and secretion. J Pharmacol Exp Ther 197:215, 1976 8. Kanta J, Kopacova L, Patockova M, et al: Effect of carbanilate local anesthetics on granulation tissue formation. Pol J Pharmacol 36:659, 1984 9. Chavapil M, Hameroff SR, O’Dea K, et al: Local anesthetics and wound healing. J Surg Res 27:367, 1979
The Effects of Articaine Hydrochloride on Wound Healing: An Experimental Study ¨ ¸cok, DDS,† Cem Korkmaz, MD,‡ Necdet Dog˘an, DDS,* Cahit U ¨ zlem U ¨ ¸cok, DDS,§ and Hakan Alpay Karasu, DDS㛳 O Purpose:
The aim of the study was to examine the effect of articaine hydrochloride (AH) on the healing of surgical wounds and to compare healing with that of lidocaine. Materials and Methods: Forty rats were used in this study. The rats were randomly separated into 4 groups. Three groups were given 2% lidocaine, 4% AH, or injectable saline, and the fourth was a control group. Skin specimens underwent the breaking strength test (BST) and histologic examination at 1 week after the surgical procedure. The skin specimens of the rats were subjected to a pulling force of 10 mm/min across the incision line. The strength value at the moment of breaking in the tissue was expressed in Newtons. Histologic examination was performed as well, and wound healing was graded. Results: Both the histologic grade and BST values in the lidocaine and AH groups were significantly lower than those of the control and saline groups (P ⬍ .01). Similarly, the histologic and BST values of the AH and lidocaine groups were statistically significant (P ⬍ .05, P ⬍ .001). Some necrotic regions were observed at the incision region in 2 samples from the AH group. Conclusion: The results of the study showed that AH is as safe a local anesthetic agent as lidocaine from the standpoint of wound response. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:1467-1470, 2003 The use of local anesthetics is one of the most widely used processes in the practice of dentistry. Various local anesthetic agents are prepared for this purpose. Practices that started with the discovery of cocaine in 1884 continued and became more widespread with the discoveries of procaine in 1904 and lidocaine in 1948.1 Thus, the painless treatment of patients was realized and constituted one of the most important practices of dentistry. Local anesthetics have various effects on the healing of surgical wounds. However, studies aiming at finding safer and more effective local
*Assistant Professor, Department of Oral and Maxillofacial Surgery, Gu ¨ lhane Military Medical Academy, Ankara, Turkey. †Associate Professor, Department of Oral and Maxillofacial Surgery, Dental Faculty, Ankara University, Ankara, Turkey. ‡Chief Resident, Department of Histology, Gu ¨ lhane Military Medical Academy, Ankara, Turkey. §Assistant Professor, Department of Oral Diagnosis and Radiology, Gu ¨ lhane Military Medical Academy, Ankara, Turkey. 㛳Chief Resident, Department of Oral and Maxillofacial Surgery, Dental Faculty, Ankara University, Ankara, Turkey. ¨ c¸ok: Address correspondence and reprint requests to Dr C. U ¨ Ankara Universitesi Dis¸ Hekimlig˘i Faku ¨ ltesi, Bes¸evler, Ankara, Turkey; e-mail: [email protected] © 2003 American Association of Oral and Maxillofacial Surgeons
0278-2391/03/6112-0014$30.00/0 doi:10.1016/j.joms.2003.05.002
anesthetic agents continue. Articaine hydrochloride (AH), a local anesthetic of the amide group, was synthesized and offered for clinical use in 1976 in Germany. The use of AH was initially limited to European countries; however, it was later used in Canada and, after the approval of the Food and Drug Administration, AH began to be used in the United States in April 2000.2 Local anesthetics are known to have modest doserelated effects on wound healing. This experimental study was prepared to examine the effect of AH on the healing of surgical wounds compared with the effect of lidocaine.
Materials and Methods Forty rats (F344) weighing between 230 and 280 g were used in this study. The study was performed in accordance with the protocol prepared with the approval of the Committee for Ethical Experiments on Animals. The rats were kept 7 days before the study in an environment that had good air circulation and heat control, and the animals had free access to water and food. The rats were randomly separated into 4 groups for this experiment. Rats that would receive 2% lidocaine (plus 1:100,000 epinephrine) constituted group 1, those that would receive 4% AH (plus 1:100,000 epinephrine) constituted group 2, those that would receive a saline solution application were group 3,
1467
1468
ARTICAINE HCl AND WOUND HEALING
fixed in the 10% formalin solutions for 2 days. The fixed tissues were blocked by using the routine paraffin method. Then the sections were dyed with Masson’s trichrome stain that dyed collagen as well. The sections were examined under a light microscope. Morphometry was performed in 40 samples by means of a microcomputer analysis system (MCID; System Imaging Research, Ontario, Canada), which allowed quantification of the neoformed collagen fibers in a randomly chosen 100 ⫻ 75 m field for each histologic sample. This examination was prepared according to 4 criteria. FIGURE 1. Microphotograph showing the stage of epithelialization in the articaine group (Masson’s trichrome stain, original magnification ⫻400).
and the control group was group 4. A 4-cm linear incision was prepared on the skin of the dorsal median line of the rats in the control group without any injection. SURGICAL PROCEDURE
All animals were subjected to inhalation anesthesia. Their dorsal regions were shaved and cleaned with povidone-iodine and dried with sterile towels. All surgical processess were performed by the same surgeon, using the same aseptic methods. Solutions of 2.5 mL were injected into 4 separate locations on both sides of the incision line, and a distance of at least 1 cm was kept between these locations and the incision line. On the dorsal median line, a 4-cm linear incision was performed up to the muscular fascia in all samples. Surgical wounds were sutured with nonabsorbable 3-0 silk. No postoperative antibiotic was used. All rats were killed on the seventh day. The tissue specimens, which had a size of 4 ⫻ 8 cm, were dissected from dorsal regions of the rats. The caudal portions of all samples were placed in a 10% formalin solution for further histologic studies. All remaining skin portions were subjected to a breaking determination test.
Stage 1: Stage of Inflammation This is the most early stage of wound healing in tissue. There is edema of tissue, many blood vessels in the form of angioblasts and effective fibroblasts, abundant lymphocytes, and macrophages. Stage 2: Development of Granulation Tissue Edema is reduced. Blood vessel formation is completed, and abundant myofibroblasts are observed in the tissue. The number of lymphocytes and macrophages are decreased. Collagenization starts. Stage 3: Development of Scar Tissue Wound healing is characterized with increased fibroblast and collagen. Epithelialization starts at the edge of the wound (Fig 1). Stage 4: Completion of Epithelialization Wound edges come closer and epithelialization is completed (Fig 2). STATISTICAL ANALYSIS
Collected data were analyzed with the statistical package SPSS 11.0 for Windows (SPSS Inc, Chicago, IL). Groups were compared statistically using the Kruskal-Wallis and Mann-Whitney U tests.
BREAKING STRENGTH TEST
The skin pieces of the rats were placed in the Lloyd LRX (LLOYD LRX, Fareham Hants, England), and a pulling force of 10 mm/min in vertical direction to (across) the incision line was applied. The strength value at the moment of breaking in the tissue was expressed in Newtons (1 N ⫽ 101.97 g). This process was applied to all samples. HISTOLOGIC EXAMINATION
The tissues were transferred into 10% formalin solutions and wound edges were reduced so as to remain in the middle. The reduced tissue samples were
FIGURE 2. Microphotograph showing the stage of epithelialization on lidocaine group (Masson’s trichrome stain, original magnification ⫻200).
1469
˘ AN ET AL DOG
Table 1. DISTRIBUTION OF THE RESULTS OF THE HISTOLOGIC EVALUATION AND BREAKING STRENGTH TEST (BST) FOR THE GROUPS
Histologic Grade Group Control (n ⫽ 10) Saline solution (n ⫽ 10) Lidocaine (n ⫽ 10) Articaine (n ⫽ 10)
Median
Mean (range)
BST (mean ⫾ SD)
4
3.7 (3-4)
12.41 ⫾ 1.45
3
3.4 (3-4)
11.36 ⫾ 1.30
2
2.2 (1-3)*
8.29 ⫾ 1.27*
1
1.5 (1-3)†
5.57 ⫾ 1.22*‡
*Differences between experimental groups with saline and control groups were statistically significant, P ⬍ .01. †Differences between lidocaine and articaine groups were statistically significant, P ⬍ .05. ‡Differences between lidocaine and articaine groups were statistically significant, P ⬍ .001.
Results Complete healing in the incision region was observed on the seventh postoperative day in all samples. Results of the histologic examination and breaking strength test (BST) are shown in Table 1 and Figures 3 and 4. As shown, both histologic grade and BST values in the lidocaine and AH groups were significantly lower than those of the control and saline groups (P ⬍ .01). Similarly, histologic and BST values of the AH and lidocaine groups were statistically significant (P ⬍ .05, P ⬍ .001) (Table 1). Some necrotic regions were observed at the incision region in 2 samples of the AH group.
Discussion Morris and Tracey,3 Eriksson et al,4 and Drucker et al examined the effects of local anesthetic agents on 5
FIGURE 3. Distribution of the results of the histologic evaluation for the groups.
FIGURE 4. Distribution of the results of the breaking strength test for the groups.
the healing of surgical wounds. Some researchers have stated that local anesthetics delay the healing of wounds, whereas others claimed that the same substances had a positive effect on the healing process. Generally, lidocaine was used, and various aspects of the effect of this substance have been observed on the healing of wounds. A particular study focused on whether lidocaine affected the healing of wounds by inhibiting collagen synthesis. To determine the safest dose, various concentrations of lidocaine were used. It was found that although 2% lidocaine substantially reduced the breaking resistance, doses of 0.5% and 1% caused no obvious difference compared with the control group. It was also observed that lidocaine caused local tissue necrosis, and we observed some necrotic regions on 2 samples of the AH group. Morris and Appleby6 focused on the effect of procaine on the healing of wounds. It was determined that doses of 1% and 2% concentrations delayed the healing of wounds and that the use of 1:100,000 epinephrine was a factor that accentuated this effect by allowing procaine to remain longer in the region. Thus, epinephrine injected alone in the region had no negative effect on the healing of wounds. Morris and Tracey3 stated that the injection of sterile water into the wound region also delayed healing of the wound, and they presumed the reason for this to be the fact that the volume of liquid injected into the skin and subcutaneous tissues causes tissue damage. It has been shown that procaine retards the healing of wounds by reducing mucopolysaccharide and, consequently, the collagen synthesis.
1470 Experimental studies have shown that lidocaine and bupivacaine reduced collagen synthesis with a mechanism that affects cell membrane stability and sodium and intracellular calcium movements in rat fibroblast cultures.7,8 Chavapil et al9 determined that local anesthetics inhibited the hydroxylase enzyme, which ensures the binding of hydroxyproline to collagen. Various views were presented, particularly in accordance with the results of studies performed with lidocaine. The dominant claim was that the contradictory results of the studies were due to the use of different experimental animals, the differences between individual immunity types, the solutions used, and the concentrations of vasoconstrictors they included.3,5,6 However, another matter that needs to be taken into account is the fact that the use of local anesthetics in the regions of general surgery compared with oral and maxillofacial surgery requires separate evaluation because of some anatomic and physiologic differences between the application regions. Consequently, if the local anesthetic solution applied onto the skin includes low concentrations of vasoconstrictors, it may have no negative effect on healing of the wound.3 However, local anesthetic solutions can be applied via 2 methods in oral and maxillofacial surgery practices: local infiltration and regional application. It is obvious that a low concentration of vasoconstrictor in the solution will have a negative effect on the work of the surgeon due to possible bleeding in the surgical region more densely in the vessels than the skin (eg, the mouth) and thus will reduce the duration of anesthesia. Oral procedures performed with regional anesthesia are farther away from the local infiltrative application region, so the concentration of the vasoconstrictor/ local anesthetic will not have a negative effect on the healing of wounds. According to this study, it has been observed that both the histologic and BST results were the best in the control group. This has been an expected result
ARTICAINE HCl AND WOUND HEALING
because various studies also reveal that local anesthetic agents cause a delay in wound healing. According to the evaluation of the histologic and BST results, there has been a statistical difference in favor of lidocaine. However, our opinion is that this has no clinical importance. Both agents are routinely used in our country and our clinical experience proves these results. Due to its high anesthetic effectiveness and low complications compared with other anesthetic agents, AH has been widely used by dentists in recent years.1,2 Its effect is not known on the soft tissue of the mouth in oral surgery or on the healing of wounds from skin incisions in maxillofacial surgery but no clinically significant effect is noted. The BST and histologic effects at 7 days cannot imply any clinically relevant delayed wound healing. In light of the results of this study, AH can be regarded as a safe local anesthetic agent for surgery in the head and neck regions.
References 1. Malamed SF, Gagnon S, Leblanc D: Efficacy of articaine: A new amide local anesthetic. J Am Dent Assoc 131:635, 2000 2. Malamed SF, Gagnon S, Leblanc D: Articaine hydrochloride: A study of the safety of a new amide local anesthetic. J Am Dent Assoc 132:177, 2001 3. Morris T, Tracey J: Lignocaine: Its effects on wound healing. Br J Surg 64:902, 1977 4. Eriksson AS, Sinclair R, Cassuto J, et al: Influence of lidocaine on leukocyte function in the surgical wound. Anesthesiology 77:74, 1992 5. Drucker M, Cardenas E, Aritzi P, et al: Experimental studies on the effect of lidocaine on wound healing. World J Surg 22:394, 1998 6. Morris T, Appleby R: Retardation of wound healing by procaine. Br J Surg 67:391, 1980 7. Feinstein MB, Fiekers J, Fraser C: An analysis of the mechanism of local anesthetic inhibition of platelet aggregation and secretion. J Pharmacol Exp Ther 197:215, 1976 8. Kanta J, Kopacova L, Patockova M, et al: Effect of carbanilate local anesthetics on granulation tissue formation. Pol J Pharmacol 36:659, 1984 9. Chavapil M, Hameroff SR, O’Dea K, et al: Local anesthetics and wound healing. J Surg Res 27:367, 1979