The Incidence of Adverse Reactions Following 4% Septocain(Articaine) in Children

Resident: Roberts

Date: 1/12/2011

Article title: The Incidence of Adverse Reactions Following 4% Septocain(Articaine) in Children

Author: Adequmi. A, et al.

Journal: Pediatric Dentistry

Volume: 30 Number: 5

Year: 2008

Background: Articaine hydrochloride originated in Germany in 1976 and has been widely used in other European countries. It was approved in April 2000 for use in the United States under the name Septocaine. It belongs to the amide group of local anesthetics and is unique in that it contains a thiophene ring and an ester group. The thiopene ring increases the lipid solubility of the anesthetic, giving it a faster onset of action. The ester group enables the drugs biotransformation in the plasma and the liver. It has a fast onset of action, profound anesthesia, and low allergenicity. It works by blocking the sodium and potassium channels during the propagation of action potential. The elimination half-time of articaine is about 20 minutes.

Purpose: The purpose of the study was to report adverse events following its use in children.

Method: A prospective study was carried out on children attending a university based pediatric clinic. Data included demographics, medical history, amount and site of injection, and treatment complexity. Follow up interviews were done by phone and conducted with the parents at 3, 5, 24, 48 hour intervals. The primary objective was to determine if there was any prolonged anesthesia, soft tissue injury and or pain.

Results: Of 264 original patients recruited for the interview, only 204 were obtained. Numbness and paresthesia was reported 40% of the time at 3 hours and 11% at 5 hours. Soft tissue injury was reported 14% of the time at 3 hours and was found to highest under the age of 7. The lip was the ost commonly affected site for injury. 20% reported post procedural pain at 3 and 5 hour interviews.

Conclusions according to author: Since prolonged numbness appears to be the most frequent adverse event and occurred primarily in children younger than 7 years old, parents need to be informed and reassured accordingly.

Assessment: The article sites a number of studies with similar results and conclusions. It appears from its long track record of use in Europe and in the U.S. that it is very good products to use when dealing with kids. Providers however need to realize that this drug has the potential to diffuse more easily through soft tissue and bone than other local anesthetics and may give a more profound and long lasting effect as well. We should use this knowlegde when counseling with parents of our patients after operative procedures to ensure their best safety.