A comparative review of epinephrine and phenylephrine as vasoconstrictors in dental anesthesia: exploring the factors behind epinephrine's prevalence in the US.

Navkiran Deol, Gerardo Alvarez, Omar Elrabi, Gavin Chen, Nalton Ferraro
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Abstract

This review paper delves into the comparative study of epinephrine and phenylephrine as vasoconstrictors in dental anesthesia, exploring their histories, pharmacological properties, and clinical applications. The study involved a comprehensive literature search, focusing on articles that directly compared the two agents in terms of efficacy, safety, and prevalence in dental anesthesia. Epinephrine, with its broad receptor profile, has been a predominant choice, slightly outperforming in the context of prolonging dental anesthesia and providing superior hemostasis, which is crucial for various dental procedures. However, the stimulation of beta-adrenergic receptors caused by epinephrine poses risks, especially to patients with cardiovascular conditions. Phenylephrine, a selective alpha-1 adrenergic agonist, emerges as a safer alternative for such patients, avoiding the cardiovascular risks associated with epinephrine. Moreover, its vasoconstrictive effect may not be as deleterious as that of epinephrine, due to its selective action. This review reveals that despite the potential benefits of phenylephrine, epinephrine continues to dominate in clinical settings, due to its historical familiarity, availability, and cost-effectiveness. The lack of commercially available pre-made phenylephrine dental carpules in most countries, except Brazil, and a knowledge gap within dental academia regarding phenylephrine, contribute to its limited use. This review concludes that while both agents are effective, the choice between them should be based on individual patient conditions, availability, and the practitioner's knowledge and familiarity with the agents. The underuse of other vasoconstrictors like levonordefrin and the unavailability of phenylephrine in pre-mixed dental cartridges in many countries highlights the need for further exploration and research in this field. Furthermore, we also delve into the role of levonordefrin and examine the rationale behind the exclusion of phenylephrine from commercially available pre-mixed local anesthetic carpules, suggesting a need for a responsive approach from pharmaceutical manufacturers to the distinct needs of the dental community.

牙科麻醉中作为血管收缩剂的肾上腺素和苯肾上腺素的比较综述:探讨肾上腺素在美国盛行的背后因素。
这篇综述论文深入探讨了肾上腺素和苯肾上腺素作为血管收缩剂在牙科麻醉中的比较研究,探讨了它们的历史、药理特性和临床应用。该研究进行了全面的文献检索,重点是直接比较两种药剂在牙科麻醉中的疗效、安全性和普遍性的文章。肾上腺素具有广泛的受体特征,一直是主要的选择,在延长牙科麻醉时间和提供对各种牙科手术至关重要的止血方面略胜一筹。然而,肾上腺素对β-肾上腺素能受体的刺激会带来风险,尤其是对心血管疾病患者。苯肾上腺素是一种选择性α-1肾上腺素能激动剂,对这类患者来说是一种更安全的替代品,可避免肾上腺素带来的心血管风险。此外,由于其选择性作用,它的血管收缩效应可能不像肾上腺素那样有害。本综述显示,尽管苯肾上腺素具有潜在的益处,但由于其历史悠久、易于获得且具有成本效益,因此在临床中仍以苯肾上腺素为主。除巴西外,大多数国家都缺乏市售的预制苯肾上腺素牙科胶囊,牙科学术界对苯肾上腺素的认识也存在差距,这些都是导致苯肾上腺素使用受限的原因。本综述的结论是,虽然两种药剂都有效,但应根据患者的具体情况、可用性以及从业人员对药剂的了解和熟悉程度来选择。其他血管收缩剂(如左氧氟沙星)的使用不足,以及苯肾上腺素在许多国家无法以预混牙科药盒的形式供应,都凸显了在这一领域进行进一步探索和研究的必要性。此外,我们还深入探讨了左诺德福林的作用,并研究了苯肾上腺素被排除在市售预混局部麻醉剂盒之外的原因,这表明制药商需要对牙科界的独特需求做出回应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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