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Title Role of Phentolamine Mesylate in Reversal of Local Anesthesia for Adult Patients
Clinical Question Does phentolamine induce reversal of soft-tissue local anesthesia faster than no treatment?
Clinical Bottom Line Phentolamine injection decreases the duration of soft-tissue local anesthesia. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18682623Hersh/2008484 subjects received local anesthesia for restorative or scaling procedures. After completion of the procedures, randomized subjects received either an injection of phentolamine or a sham injection (an injection where the needle does not penetrate the soft tissue) at the same site as the local anesthetic. randomized, double-blind randomized controlled trial
Key resultsResults were measured every 5 minutes for a 5-hour duration using standardized lip- and tongue-tapping procedures, along with other functional measures and subject-perceived altered function, sensation, appearance and safety. Median recovery times for lower lip and tongue for subjects in the phentolamine group were 70 and 60 minutes, respectively, while in the sham group these times were 155 and 125 minutes, respectively. Upper lip median recovery times for the phentolamine group were 50 minutes, while in the sham group this duration was 133 minutes. The results indicate a significant difference (P < .0001).
Evidence Search PubMed MESH search: \"Phentolamine\"[Mesh] AND \"Anesthesia, Local\"[Mesh]
Comments on
The Evidence
Large patient population and significant differences in test and control groups.
Applicability This article is has direct applicability in a clinic setting, where phentolamine may be administered to patients in an attempt to reduce the effects of local anesthesia. Public speakers and high-profile executives may appreciate an unanaesthetized lip prior to meetings, speeches, or other appointments. Phentolamine is also used in pediatric dentistry to avoid post-treatment labial trauma. The drug is contraindicated for use in patients after invasive surgical procedures such as extraction’s or periodontal surgeries.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords phentolamine; local anesthesia; soft tissue anesthesia; reversal; duration;
ID# 487
Date of submission: 01/07/2010spacer
E-mail naomiseverdds@gmail.com
Author Mohammed Ahmed Subhani
Co-author(s) Naomi Sever
Co-author(s) e-mail
Faculty mentor/Co-author Ernest Valdez, DDS
Faculty mentor/Co-author e-mail VALDEZE@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Sarah Clegg (San Antonio, TX) on 04/14/2012
A PubMed search on this topic in April of 2012 reveals that there is a more recent study on this subject, which has a PubMed ID: 21924181. This is a RCT on 85 subjects, and also finds that phentolamine is beneficial for anesthesia reversal.

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