Minimum Dosage Technique in the Clinical Comparison of Representative Modern Local Anesthetic Agents

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Abstract
An analysis of 1254 personal injections using minimum dosage technique (dose range of 0.25-1.0 ml) in every area of the mouth allowed comparison of a series of parameters notably onset time, efficiency rate, extent and duration in rapid acting modern anesthetic agents (Procaine, Lidocaine, Mepivacaine, Hostacaine, and L67 (Citanest). Strict criteria were laid down including a time limit for the onset of successful anesthesia of 4[image]30". Standard lidocaine (Xylocaine 2% with epinephrine 1/80 - 100,000) had the fastest onset time (1[image]20") highest potency and greatest efficiency; duration was partly controlled by dosage. Mepivacaine was less reliable (efficiency 96% against 98% lidocaine) and slower, (onset 2[image] 20") but of shorter duration. L67 was highly consistent (onset 2[image]) efficiency (97%) and shortest in duration (1 hr 30[image]). It was the least toxic of any agent tested. Ultra short duration was obtainable with L67 4% without epinephrine (less than 1 hour). Tables showed statistical breakdown for every solution for every position in the mouth and from the material a system for preliminary clinical grading of new agents in 25 injections using minimum dosage technique and "easy" and "difficult" areas, was propounded. The role of the vasoconstrictor in anesthetic solutions was discussed and based on its clinical behaviour, suggestions were made as to suitable concentrations. Methods for controlling duration were also explained. The effects of varying the concentration of the agent and/or epinephrine contents were also studied over a wide range.