Effects Of Epinephrine In Association With Anesthesia In Dental Intervention In Patients With Heart Failure. Results Of The Double-Blind Controlled Trial (Teeth-Hf Study)

Introduction: The use of a local anesthesia solution with vasoconstrictor for the dental intervention of patients with heart disease is controversial since it could generate adverse cardiovascular risk. Also, its safety has not been investigated in patients with heart failure (HF). Hypothesis: The objective of this study was to evaluate the cardiovascular risk and pain score after dental intervention under local anesthesia with and without epinephrine, specifically tooth extraction and restoration, in patients with HF. Methods: Prospective, parallel group, controlled, double-blind study. Patients with HF, ejection fraction <45%, functional class II and III/IV and with optimized therapy were randomized to dental intervention using anesthesia solution lidocaine without epinephrine (LW) or anesthesia solution lidocaine with epinephrine (LE). Results: Seventy-two patients (50+/-10 years, 62% male, 27% ischemic) were randomized to LW (n=36) or LE (n=36). Systolic and diastolic blood pressure (BP) increased and maximum heart rate (HR) decreased significantly during intervention in relation to baseline phase in both groups (LW: BP, 120/79 to 125/82 mmHg and HR, 88 to 85 bpm, p<0.05; LE: BP, 116/75 to 124/78 mmHg and HR, 91 to 83 bpm, p<0.05). No differences were observed in BP, HR, arrhythmias and pain score before, during and after the dental intervention between the groups. However, it was observed a significant increase in the pain scale for the dental extraction in the LW group in comparison to the LE. Conclusions: Local anesthesia solution lidocaine with epinephrine seems to be safe and effective in patients with heart failure. This treatment did not cause adverse cardiovascular effects, and the pain score was lower in patients receiving LE in comparison with patients receiving LW. Patients with HF may benefit from the anesthesia solution with epinephrine for the dental intervention.