Local anesthesia in dentistry: reviews. Ubistezin, solution for submucosal injections in dentistry Ubistezin elimination period from the body

Composition

Active ingredients: 1 ml articaine hydrochloride 40 mg, epinephrine hydrochloride 0.006 mg (equivalent to 0.005 mg epinephrine)

Excipients: anhydrous sodium sulfite (E 221), hydrochloric acid 14%, sodium hydroxide solution 9%, sodium chloride, water for injection.

Dosage form"type="checkbox">

Dosage form

Injection.

Basic physical and chemical properties: transparent, without opalescence, colorless liquid.

Pharmacological group"type="checkbox">

Pharmacological group

Preparations for local anesthesia. Artikain, combinations.

Pharmacological properties"type="checkbox">

Pharmacological properties

Pharmacological.

Ubistezin contains Articaine, which is an amide-type local anesthetic for use in dentistry. It causes a reverse delay in the sensitivity of autonomic, sensory and motor nerve fibers. It is believed that the mechanism of action of articaine is the blocking of voltage-dependent sodium channels of the nerve fiber membrane.

Characterized by a rapid onset of pain relief (waiting period - from 1 to 3 minutes), a reliable strong analgesic effect and good local tolerance.

The duration of action of ubistezin during pulpal anesthesia is at least 45 minutes, with soft tissue anesthesia - from 120 to 240 minutes.

Adrenaline (epinephrine) causes local vasoconstriction, slows down the absorption of articaine. The result is an increased concentration of local anesthetic at the injection site and a longer duration of action, as well as a reduction in the likelihood of systemic side effects.

Pharmacokinetics.

Ubistezin is rapidly and almost completely absorbed.

The maximum level of articaine in blood plasma with intraoral injection is reached after 10-15 minutes. The volume of distribution is 1.67 l / kg, the half-life (T 1/2) is approximately 20 minutes, the time to reach the maximum plasma concentration (T max) is 10-15 minutes.

Articaine binds to plasma proteins up to 95%. It is rapidly hydrolyzed by plasma cholinesterase to its primary metabolites articaic acid, which are further metabolized to articaic acid glucuronide. Articaine and its metabolites are excreted by the kidneys. Adrenaline (epinephrine) is rapidly degraded in the liver and other tissues. Metabolites are excreted by the kidneys.

Indications

Local (infiltration and conduction) anesthesia in dentistry with minor interventions.

Contraindications

• Hypersensitivity to articaine or other local anesthetics of the amide type, epinephrine (adrenaline), sulfites, as well as to any of the auxiliary components of the drug
• paroxysmal tachycardia and other tachyarrhythmias;
• acute heart failure, unstable angina, recent myocardial infarction (3 to 6 months ago), recent coronary bypass surgery (3 months ago), refractory arrhythmia and paroxysmal tachycardia or high-frequency arrhythmia continued, untreated or uncontrolled congestive heart failure, violation of the conduction of the heart (block II-III degree, documented bradycardia), severe arterial hypertension, severe arterial hypotension;
• bronchial asthma severe and with increased sensitivity to sulfites;
• glaucoma;
• simultaneous use of non-selective b-blockers;
• severe liver failure (porphyria)
• hemorrhagic diathesis (increased risk of bleeding), especially with conduction anesthesia
• violation of the activity of cholinesterase in the blood plasma in history (including forms of the disease caused by drugs);
• hyperthyroidism
• pheochromocytoma;
• methemoglobinemia, hypoxia, intolerance to sulfonic groups (especially in bronchial asthma)
• diabetes severe degree;
• simultaneous terminal anesthesia;
• injection into inflamed area(decreases the effectiveness of local anesthesia)
• patients who are being treated with tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs), and within 14 days after stopping treatment with MAOIs (MAOIs)
• children under the age of 4 years.

The introduction of the drug is contraindicated!

Special Security Measures

Before the injection, it is necessary to conduct a skin test for hypersensitivity to the drug.

Before using this medication, you must:

• ask about the patient's medical history, indicating the treatment he is currently undergoing;
• if there is a possible risk of allergy, perform a test injection by administering 5% to 10% of the dose.

Injection should be carried out slowly, performing aspiration test in at least two planes (needle rotation - 180º) to avoid intravascular injection. Maintain verbal contact with the patient.

After the onset of anesthesia, there is a risk of unintentional injury as a result of biting the mucous membrane of the lip, cheek or tongue. The patient should be warned not to chew during the anesthesia.

Injections into infected or inflamed tissues should be avoided (the effectiveness of local anesthesia decreases).

Interaction with other medicinal products and other forms of interaction

• guanethidine and related drugs (antiglaucoma agents). Significant increase blood pressure(hyperreactivity, associated with a decrease in sympathetic tone and / or with a slowdown in the penetration of adrenaline into sympathetic fibers). If this combination cannot be avoided, lower doses of sympathomimetics (epinephrine) should be used cautiously
• MAO inhibitors. Increasing the effect of adrenaline on blood pressure.

Combinations that require action due to the presence of adrenaline:

• halogenated mild anesthetics: severe ventricular arrhythmias (increased cardiac excitability). The administration of anesthetic should be limited, for example, less than 0.1 mg of adrenaline over 10 minutes or 0.3 mg over 1 hour in adults,
• Imipramine antidepressants: paroxysmal hypertension with possible arrhythmias (inhibition of the penetration of adrenaline into sympathetic fibers). The administration of the anesthetic should be limited, for example, less than 0.1 mg of adrenaline over 10 minutes, or 0.3 mg over 1 hour in adults,
• serotonergic and noradrenergic antidepressants (antidepressants from the group of selective serotonin and norepinephrine reuptake inhibitors - typical for minalsipran and venlafaxine). Possible paroxysmal hypertension with possible arrhythmias (inhibition of the penetration of adrenaline into the sympathetic fibers). The administration of the anesthetic should be limited, for example, to less than 0.1 mg of adrenaline over 10 minutes, or 0.3 mg over 1 hour in adults. The local anesthetic effect of articaine enhances and lengthens the vasoconstrictor medicines.

You should not prescribe the drug against the background of treatment with non-selective b-blockers, since in this case the risk of developing hypertensive crisis and severe bradycardia.

Adrenaline can block the release of insulin from the pancreas, causing the drug to reduce the effectiveness of oral antidiabetic agents.

Some inhalation anesthetics (eg, halothane) can increase myocardial sensitivity to catecholamines, contributing to the development of arrhythmia.

Phenothiazines may reduce or reverse the vasopressor action of adrenaline.

With the simultaneous use of antithrombotic agents (heparin, acetylsalicylic acid), the frequency of bleeding increases. Accidental puncture of vessels during local anesthesia can cause severe bleeding.

The drug should be used with caution hypoglycemic, antiarrhythmic (procainamide, mexilitine, disopyramide, quinidine, amiodarone), antiepileptic drugs, cardiac glycosides, hormones thyroid gland.

Differences in the interaction of ubistesin with other drugs in children / adolescents compared with adults were not observed.

Application features

Ubistezin should be used with extreme caution in the following cases:

• severe renal impairment;
• angina pectoris
• arteriosclerosis;
• significant deterioration in blood clotting or treatment with anticoagulants (see section "Interaction with other medicinal products and other forms of interaction");
• diabetes
• lung diseases, especially allergic asthma.

Because amide-type local anesthetics are also metabolized in the liver, ubistezin should be used with caution in patients with liver disease. Patients with acute liver disease are at increased risk of developing toxic plasma concentrations of articaine.

The drug should be used with caution in patients with cardiovascular disease (eg, heart failure, coronary heart disease, history of myocardial infarction, cardiac arrhythmia, arterial hypertension), as they have less ability to compensate for the functional changes associated with prolongation of arteriovenous conduction caused by these drugs. facilities.

The drug should be used with caution in patients with a history of epilepsy, it is especially necessary to avoid the use of high doses, as well as in patients with significantly severe anxiety, disorders cerebral circulation, history of stroke.

Caregivers of young children should be warned about the possibility of soft tissue injury due to biting as a result of prolonged soft tissue numbness after anesthesia.

There may be a positive result when conducting doping tests in athletes.

It must be borne in mind that during treatment with blood clotting inhibitors (for example, heparin or aspirin), inadvertent puncture of the vessel with the introduction of a local anesthetic can lead to serious bleeding and a general increase in the possibility of bleeding (see Section "Interaction with other drugs and other forms of interaction") .

It is necessary to avoid accidental intravascular injection (see section "Method of administration and dose", subsection "Method of administration"). Accidental intravascular administration or unintentional overdose may cause convulsions and cases of central nervous system depression. nervous system(CNS) or cardiorespiratory failure. Resuscitation equipment, oxygen and medicines for emergency care must be available for immediate use.

During the treatment of the cavity of the tooth or the treatment of the tooth under the crown, it must be taken into account that due to the content of adrenaline in the preparation, the blood flow in the pulp tissues decreases and, thus, there is a risk of not noticing an accidentally opened pulp.

This medicinal product contains less than 1 mmol sodium chloride (0.033 µmol equivalent

0.76 mcg sodium) per 1.7 ml, i.e. the drug is actually "sodium-free".

Ubistezin should be used with extreme caution in patients who are taking phenothiazines or cardioselective b-blockers (see Section "Interaction with other medicinal products and other forms of interaction").

precautionary measures

Each time a local anesthetic is used, the following drugs/treatments should be available:

• anticonvulsants (drugs to treat seizures, such as benzodiazepines or barbiturates), muscle relaxants (drugs that reduce muscle tension, voluntarily contract), atropine, vasoconstrictors (drugs to treat low blood pressure), or epinephrine for acute allergic or anaphylactic reactions;
• resuscitation equipment (especially oxygen sources) for artificial respiration if necessary;
• careful and continuous monitoring of cardiovascular and respiratory (breathing adequacy) indicators of the state of the body and the state of consciousness of the patient after each injection of local anesthetic.

Restlessness, anxiety, tinnitus, dizziness, blurred vision, trembling, depression or drowsiness are the first signs of CNS toxicity (see section "Overdose").

Use during pregnancy or lactation

There are no clinical data on the use of the drug in pregnant women and women during breastfeeding. Safety of local anesthetics during pregnancy side effects on fetal development has not been established. Animal studies on the use of articaine do not indicate direct or indirect negative effects on pregnancy, embryonic / fetal development of the fetus, childbirth or postnatal development. Animal studies with epinephrine have found reproductive toxicity. The potential risk to humans is unknown.

Ubistezin should be used during pregnancy only if the benefit outweighs the potential risk to the fetus.

It is not known whether Articaine and its metabolites pass into breast milk. However, preclinical safety data suggest that the concentration of articaine in breast milk does not reach clinically significant levels. So, breastfeeding should express the first milk after anesthesia with Articaine.

In animal studies, no adverse effects of ubistesin on fertility were observed.

The ability to influence the reaction rate when driving vehicles or operating other mechanisms

Although studies on patients have not shown a deterioration in normal responses to driving, the physician must decide in each individual case whether the patient is capable of driving vehicles or mechanical means. After the injection, the patient must remain in the dentist's office for at least 30 minutes.

Dosage and administration

Designed for adults and children over 4 years old.

To ensure effective anesthesia, the necessary minimum solution should be used.

For the extraction of upper teeth, 1.7 ml of ubistesin per tooth is usually sufficient and there is no need to make painful injections to the palate. With the successive removal of adjacent teeth, it is possible to reduce the dose of the injection.

If it is necessary to make a palatal incision or sutures, a palatal anesthesia of approximately 0.1 ml per injection should be given.

For uncomplicated extractions of lower premolars under infiltration anesthesia, 1.7 ml of ubistesin per tooth is usually sufficient. In some cases, a further injection of 1 to 1.7 ml in the buccal region may be required. Rarely, an injection into the mandibular foramen can be given.

Vestibular injections of 0.5 to 1.7 ml of ubistesin per tooth make it possible to process the stump of teeth for restorations and orthopedic constructions.

Conduction anesthesia can be used to treat lower premolars.

In general, for children weighing 20-30 kg, a sufficient dose of 0.25-1 ml for children weighing 30-45 kg is from 0.5 to 2 ml.

Given that Articaine is rapidly distributed in tissues and its density in the bone tissue of children is lower than in adults, children and adolescents can use conduction anesthesia instead of infiltration.

Ubistezin should not be used in children under 4 years of age.

In elderly patients, elevated plasma levels of ubistesin may occur due to a weakened metabolic process and a low volume of distribution. The risk of accumulation of ubistesin is increased especially after repeated injections (eg, additional injection).

A similar effect can occur in the general weakened condition of the patient, as well as in violation of the functions of the heart, liver and kidneys. In such cases, it is recommended to reduce the dose (the minimum amount for sufficient pain relief).

Dosing for patients with certain diseases (angina pectoris, arteriosclerosis) must be reduced in the same way.

adults

Maximum dose for healthy adults is 7 mg articaine / kg (500 mg for a patient weighing 70 kg), which corresponds to 12.5 ml of ubistesin.

The maximum dose is 0.175 ml/kg body weight.

Children aged 4+

The amount of the administered drug should be determined depending on the age, body weight and duration of the operation. Exceed the equivalent of 7 mg articaine/kg (0.175 ml ubistesin/kg body weight).

Ubistezin can be used for short-term procedures and/or when control of surgical field bleeding is not important (see the Pharmacological properties section for more information on the duration of anesthesia).

For mucosal injection oral cavity.

ONLY FOR ANESTHESIA IN DENTISTRY.

Before use, the drug should be assessed visually for the presence of individual lobules, discoloration and damage to the container. The cartridge should not be used if these signs and defects appear.

To administer the drug, special reusable cartridge syringes should be used. Immediately before using the cartridge, the rubber stopper, crimped with an aluminum cap, is pierced with an injection needle, and must be disinfected with alcohol.

Under no circumstances should cartridges be immersed in any solutions.

Solution for injection must not be mixed with any other drug in the same syringe.

To avoid intravascular injections, aspiration test in at least two planes (needle rotation - 180º) should always be carefully performed, although a negative aspiration result does not rule out an unintentional and unnoticed intravascular injection.

Most systemic reactions as a result of accidental intravascular injection can be avoided in most cases by proper injection technique after aspiration - slow injection of 0.1-0.2 ml and slow administration of the remainder no earlier than 20-30 seconds.

The rate of administration of the drug should not exceed 0.5 ml in 15 seconds, that is, 1 cartridge in 1 minute.

Cartridges with the rest of the solution after the end of the dental intervention must be destroyed. Do not use cartridges with residual solution for other patients.

Children

Ubistezin can only be used in children over 4 years of age, since the efficacy and safety of the drug in young children have not been established.

Overdose

The most serious manifestations of Articaine intoxication affect the central nervous system and the cardiovascular system.

Symptoms that may be caused by Articaine

From the side of the cardiovascular system: arterial hypertension, arterial hypotension, agitation, palpitations, angina pectoris, generalized vasoconstriction, conduction disturbances, arrhythmia, bradycardia, cardiovascular collapse, cardiac arrest.

From the side of the central nervous system: headache, nervousness, anxiety, restlessness, stupor, coma, confusion, dizziness, tinnitus, taste disturbance, nausea, vomiting, tremor, involuntary muscle contractions, tachypnea, anxiety, drowsiness, loss of consciousness, tonic-clonic convulsions, respiratory arrest .

The most dangerous symptoms are: arterial hypotension, cardiac arrest, conduction disturbances, tonic-clonic epileptic seizures, respiratory paralysis and drowsiness/coma.

Symptoms that may be caused by epinephrine (adrenaline)

Circulatory disorders: increased systolic blood pressure, increased diastolic blood pressure, increased venous pressure, increased pressure in the pulmonary artery, arterial hypotension.

Cardiac disorders: bradycardia, tachycardia, arrhythmias (eg, atrial tachycardia,

AV block, ventricular tachycardia, ventricular extrasystole).

These symptoms, as well as pulmonary edema, cardiac arrest, kidney failure and metabolic acidosis can lead to life-threatening consequences.

If the initial signs of an adverse reaction or toxic effect develop during the administration of the drug, the injection should be stopped and the patient transferred to horizontal position. It is necessary to ensure the patency of the respiratory tract, control the pulse and blood pressure. It is recommended that symptomatic infusions be initiated, even if symptoms do not appear to be severe, to ensure reliable intravenous access. In case of respiratory failure, prescribe oxygen depending on the severity of the condition; if necessary, apply artificial respiration (mouth to nose) or tracheal intubation in combination with controlled ventilation.

Analeptics of the central action are contraindicated.

Involuntary muscle contractions or generalized muscle spasms require short- or ultra-short-acting barbiturate injections.

It is recommended to administer barbiturates slowly, depending on the identified action, while continuing the use of oxygen and monitoring of cardiac activity, in order to avoid the risk of circulatory disorders and respiratory depression. The introduction of barbiturates should be accompanied by an infusion of fluid through a previously installed cannula. Counteracting tachycardia and lowering blood pressure is often possible by simply placing the patient in a horizontal position or in a position in which the legs are raised slightly above the head.

In severe circulatory disorders, as well as in shock, regardless of the cause, the following measures should be taken after stopping the injection: ensure the patient is in a horizontal position with barely raised legs, as well as airway patency, oxygen insufflation. In addition, an intravenous infusion of a balanced electrolyte solution should be established: intravenous administration glucocorticoids (eg, 250-1000 mg methylprednisolone), fluid replacement (if necessary, also plasma substitutes and human albumin). In cases of threatening circulatory collapse and increasing bradycardia, immediate intravenous injection of epinephrine (adrenaline). To do this, dilute 1 ml of adrenaline solution 1: 1000 to 10 ml and inject slowly at first

0.25-1 ml of this solution (0.025-0.1 mg of adrenaline). Pulse rate and blood pressure should be monitored. Do not inject more than 1 ml of this solution (0.1 mg adrenaline) at a time. If this dosage is insufficient, epinephrine should be added to the infusion solution (set the infusion rate according to the pulse rate and blood pressure).

Severe forms of tachycardia or tachyarrhythmia can be eliminated by the use of antiarrhythmic drugs (but not non-selective b-blockers).

The use of oxygen and monitoring of circulatory parameters in all these cases are mandatory. With an increase in blood pressure in patients with arterial hypertension, peripheral vasodilators should be used.

Adverse reactions

IN general application ubistesin is regarded as very safe. In this case, it is difficult to assess the causal relationship (precise differentiation is not possible), since the causes of adverse reactions may be related to the underlying dental disease, dental intervention, or the use of local anesthesia.

Most often in clinical research the following adverse reactions are observed - pain or pain as a result of the intervention (4%), as well as sensitivity, headache and swelling

(1-1.3%). The occurrence of nervous disorders as adverse reactions in clinical studies was observed infrequently or rarely. Post-marketing data supported the profile of adverse reactions observed in published clinical trials, but indicated a lower overall frequency.

Based on post-marketing studies, the overall risk of sensory disturbances (eg, hypesthesia, paresthesia, taste disturbances) should be considered low. In case of suspected hypersensitivity reactions, an appropriate allergy test is recommended.

Sodium sulfite (E 221) may rarely cause hypersensitivity reactions and bronchospasm.

The drug is usually well tolerated by patients, but the following adverse reactions may develop:

From the side immune system: allergic reactions, in severe cases - anaphylactic shock, angioedema of varying severity (including swelling of the upper and / or lower lip and / or neck, glottis with difficulty swallowing, urticaria, difficulty breathing).

From the side of the psyche: anxiety, concern.

From the nervous system: headache, paresthesia, steam, hypo- and dysesthesia, metallic taste in the mouth, taste disturbance, tinnitus, dizziness, yawning, peripheral neuropathy, drowsiness, fainting, tremor, nervousness, agitation, insomnia, disorientation, clouded state of consciousness, loss of consciousness, loss of taste, nystagmus, logorrhea, hypergeusia, hypoesthesia of the face, decreased muscle tone, paralysis of the 6th cranial nerve, paralysis facial nerve, impaired consciousness, muscle twitching, tonic-clonic convulsions, coma, respiratory paralysis.

From the side respiratory systems s, organs chest and mediastinum: nasal congestion, dysphonia, shortness of breath, laryngeal edema, pharyngeal edema, pulmonary edema, bronchospasm, rhinitis, tachypnea, bradypnea, which may result in apnea.

From the side of the cardiovascular system: lowering blood pressure, bleeding, pallor, increased blood pressure, palpitations, tachycardia, bradycardia, cardiovascular depression with arterial hypotension, which can lead to collapse, cardiac arrhythmia ( ventricular extrasystoles and ventricular fibrillation), conduction disorders (blockade). These manifestations can cause cardiac arrest.

On the part of the organ of vision: mydriasis, ptosis, miosis, endophthalmos, blepharospasm, blurred vision, blurred vision, transient blindness, decreased visual acuity, diplopia, conjunctivitis.

On the part of the hearing and vestibular apparatus: vertigo, ear pain, ringing in the ears.

From the skin and subcutaneous tissue: redness of the skin, urticaria, itching, hyperhidrosis, rash, angioedema.

From the musculoskeletal system and connective tissue: back pain, muscle tension, osteonecrosis.

From the digestive tract: gingivitis, nausea, vomiting, diarrhea, abdominal pain, cheilitis, constipation, dry mouth, dyspepsia, oral ulcers, tooth loss, hypersalivation, increased tooth sensitivity, stomatitis, oral hypoesthesia, oral edema, paresthesia of the oral cavity.

Others: chills, when using high doses - methemoglobinemia.

General disorders and reactions at the injection site: asthenia, chills, fatigue, malaise, thirst, pain, pain on pressure, swelling or inflammation at the injection site, hematoma at the injection site, necrosis at the injection site, mucosal inflammation, mucosal edema ; in case of violation of the injection technique - nerve damage (up to the development of paralysis).

Extremely rare - accidental intravascular injection can lead to the development of ischemic zones at the injection site, sometimes progressing to tissue necrosis.

Investigation: decrease in blood pressure, increase in heart rate, increase in blood pressure, signs of myocardial ischemia (ECG), violations of vital functions, positive allergy test, blood pressure cannot be measured, decrease in heart rate.

Injuries, poisoning and complications of the intervention: pain from the intervention, injuries of the oral cavity, incorrectly chosen route of administration, nerve damage, gum injuries, wound complications.

Description of individual adverse reactions

Nerve dysfunction

Nerve dysfunction in dentistry can occur for a variety of reasons. They can be caused by underlying dental disease, dental treatment, and direct adverse reactions associated with the use of local anesthetics. Given the frequency of these two adverse reactions, the risk of such disorders is low. Most of these side effects are reversible.

From this article you will learn:

• anesthesia in dentistry - drugs,
• types of anesthesia in dental treatment,
• pain relief during pregnancy and breastfeeding.

The article was written by a dental surgeon with more than 19 years of experience.

Local anesthesia is a type of anesthesia, the meaning of which is to block the transmission of pain impulses from the area where the intervention is performed. Options for local anesthesia in dentistry include infiltration, conduction or application anesthesia. They allow you to anesthetize only the area where the intervention is planned (this can be a group of teeth or a fragment of the jaw), while the patient is conscious.

For local anesthesia in dentistry, medicines are used, which are called the term "local anesthetics". But in some cases, for example, with major surgical interventions or panic fear a person before treatment or extraction of teeth - can also be used, in which, along with pain sensitivity, the patient's consciousness is temporarily turned off. General anesthesia carried out with the help of narcotic analgesics administered intravenously or by inhalation (Fig. 3).

Local and general anesthesia in dentistry -

The very first local anesthetic in dentistry is, which, however, did not allow to achieve pronounced anesthesia, and practically did not anesthetize the inflamed tissues. Later, it appeared, which in terms of effectiveness was already about 2-2.5 times stronger, but like novocaine, it did not allow achieving great depth and duration of anesthesia. The real revolution occurred with the advent of anesthetics of the articaine series (based on articaine hydrochloride), which additionally contained vasoconstrictors.

The most popular local anesthetics in dentistry based on articaine are Ultracaine, Ubistezin, Alfacaine, Septanest and others. To further increase the depth and duration of anesthesia, vasoconstrictors began to be added to these drugs. The latter constrict blood vessels at the injection site of the anesthetic, thereby reducing the rate of its leaching from the tissues. The most commonly used vasoconstrictor is epinephrine at a concentration of 1:100,000 and 1:200,000.

Local anesthesia in the treatment and extraction of teeth -

If earlier novocaine and lidocaine were produced in the form of vials or ampoules, and injections with these drugs were performed using ordinary 5.0 ml disposable syringes, now all modern anesthetics are produced in the form of disposable carpool(cartridges). Each cartridge usually contains 1.7 ml of anesthetic, and before anesthesia it is inserted into a special cartridge syringe. Next, a very thin needle is screwed on (many times thinner than conventional needles for disposable syringes), after which the syringe is ready for use.

What does a carpool syringe look like?

The cost of anesthetics and anesthesia –
the cost of one anesthetic cartridge at the end of 2020 (be it ultracaine, ubistezin, septanest or others) will be approximately 40-50 rubles. It is at this price that dental clinics buy anesthetics. But the total cost of anesthesia in the treatment of teeth in a dental clinic will be about 400-500 rubles for 1 cartridge of anesthetic.

It is also worth noting that anesthesia in the treatment and extraction of teeth in dentistry is included in the guarantee program of the health insurance fund. Therefore, anesthesia in state dental clinics should be free of charge, but only when using Lidocaine or Novocaine (imported anesthetic will be paid). Next, we will talk about the types of anesthesia in dentistry.

Types of anesthesia in dentistry - infiltration, conduction, application

As we said above, local anesthesia can be applied, infiltration or conduction. Application anesthesia in dentistry is used to anesthetize the oral mucosa by applying 10% lidocaine in the form of a gel or spray. Especially often this type of anesthesia is used in children to preliminarily anesthetize the injection site of the needle. Lidocaine spray is often sprayed on the root of the tongue in patients with an increased gag reflex.

Infiltration anesthesia in dentistry - most often performed in the treatment and extraction of any teeth upper jaw, as well as in the region of the anterior teeth of the lower jaw. In this case, the injection is carried out in the area transitional fold in the projection of the root of the tooth, which we will remove or treat (the transitional fold is the zone of transition of the tightly attached mucous membrane to the mobile mucous membrane of the cheek or lip). After the introduction of an anesthetic into the tissues, an infiltrate is formed in them, from which the anesthetic quickly penetrates into the jaw bone tissue.

Conduction anesthesia - in dentistry it is most often used to anesthetize 6-7-8 lower teeth (less often than other teeth). This is due to the fact that the bone tissue of the lower jaw is denser and thicker - especially in the last teeth. And therefore, if we do infiltration anesthesia in the lower molars, then the anesthetic simply will not penetrate into the bone and, accordingly, the patient will experience pain. And in this case, conduction anesthesia (mandibular or torusal) will help us - the injection is made into the nerve trunk, passing approximately in the middle of the inner surface of the lower jaw branch.

Infiltration and conduction anesthesia (video 1-2) -

How long does dental anesthesia take?
the effect of infiltration anesthesia on the upper jaw occurs within a few minutes, and lasts from 15 to 45 minutes (this depends on the type of anesthetic and the concentration of the vasoconstrictor in it). The onset of anesthesia is signaled to us by the appearance of numbness in the cheek area or upper lip. The effect of conduction anesthesia on the lower jaw occurs in 5-10 minutes, but it can last from 1 hour to several hours. The following symptoms will tell us about the onset of anesthesia - there must be a pronounced numbness of half of the lower lip, as well as the tip of the tongue.

Important : if, after conduction anesthesia in the lower jaw, the numbness of half of the lip is weak or completely absent, then the doctor missed and could not remove the anesthetic near the lower lunar nerve (it is this nerve that passes on the inner surface of the lower jaw branch, providing pain sensitivity of the teeth on this side). And in this case, you should either ask the doctor to repeat the anesthesia, otherwise the treatment will be painful.

Yes, and I would like to note that in most cases, poor anesthesia is associated only with the doctor's mistakes, i.e. with violation of the technique of conduction anesthesia. This type of anesthesia is the most difficult in a general dental appointment, and not all doctors confidently perform conduction anesthesia. Nevertheless, there are a number of patients in whom it is impossible to achieve good anesthesia in principle. These include patients who abuse analgesics, as well as alcohol and drugs.

What to do if you are afraid of anesthesia -

Indeed, an anesthetic injection can be painful. Soreness will depend both on the pain threshold of the patient himself, and on the technique of anesthesia by the doctor. According to the rules, a solution of one anesthetic cartridge (1.7 ml) is excreted into the tissues within 40-45 seconds. If the doctor saves time, then it is logical that the rapid introduction of the solution will cause pain.

2) Ubistezin - instructions for use

3) Septanest: instructions for use

4) Scandonest: instructions for use

Which anesthetic is right for you - summary

• With bronchial asthma or high allergies –
  here you need an anesthetic without preservatives (usually sodium disulfite is used in anesthetics, which is needed to stabilize epinephrine or adrenaline). Therefore, the anesthetic "Ultracain D", which does not contain preservatives at all, is best for such patients.

• With thyroid disease, diabetes –
  in this case, you also do not want to use anesthetics containing vasoconstrictor components - adrenaline, epinephrine. The drug of choice, for example, "Ultracain D", "Scandonest" or "Mepivastezin". But, choosing between these three anesthetics, I would prefer the first.

• If you have high blood pressure and heart disease –
  with moderate hypertension and compensated heart diseases, the optimal choice is anesthetics containing a concentration of epinephrine (adrenaline) - 1: 200,000. It can be anesthetics "Ultracain DS" or "Ubistezin 1: 200000".

  In severe hypertension, decompensated heart disease, it is necessary to use anesthetics that do not contain adrenaline and epinephrine. Suitable then, for example, "Ultracain D".

• If you are a healthy person –
  if you do not have the above diseases, then you can safely put anesthetics containing epinephrine / adrenaline at a concentration of 1: 100,000. Moreover, a person weighing about 70 kg can be given up to 7 cartridges of anesthetic, inclusive. An example of such anesthetics is "Ultracain DS forte", "Ubistezin forte" and analogues.

Anesthesia in dentistry during pregnancy and breastfeeding -

One of the most common questions is whether it is possible to treat pregnant women's teeth with anesthesia. Anesthesia in dentistry during pregnancy and breastfeeding really has its own characteristics. The safest anesthetic here is Lidocaine (safety category "B"), and it is desirable to use it with a small concentration of a vasoconstrictor 1: 200,000.

The presence of the latter not only makes it possible to enhance anesthesia, but also to reduce the peak concentration of the anesthetic in the blood, which will further reduce the effect of the anesthetic on the fetus, as well as reduce its passage into breast milk. Drugs with vasoconstrictors are contraindicated in pregnant women only in the presence of high blood pressure and chronic fetal hypoxia. Therefore, the most optimal anesthetic would be Xylonor(preparation of 2% lidocaine in carpules, with an epinephrine content of 1:200,000), or any similar anesthetics based on lidocaine.

As for drugs based on articaine, they will already belong to the “C” safety category, which, in principle, is also considered to be sufficiently safe, but a little less. Of the anesthetics during pregnancy based on articaine, it is better to choose Ultracaine DS (with an epinephrine content of 1: 200,000). And only if the pregnant woman has high blood pressure or fetal hypoxia, we choose an anesthetic without a vasoconstrictor, for example, Ultracaine D.

Some doctors use anesthetics Scandonest or Mepivastezin for pain relief in pregnant women (they do not contain either adrenaline or epinephrine). But it is undesirable to use such anesthetics in pregnant and lactating women, because. due to the lack of a vasoconstrictor component, they are quickly absorbed into the blood. This results in a high concentration of the anesthetic in the blood, allowing it to cross the placenta more easily. In addition, both Scandonest and Mepivastezin are 2 times more toxic than novocaine. We hope that our article on the topic: Local anesthesia in dental treatment turned out to be useful to you!

Sources:

1. Higher prof. the author's education surgical dentistry,
2. Based on personal experience as a dental surgeon,
3. National Library of Medicine (USA),
4. "Local anesthesia in dentistry" (Baart J.),
5. "Propaedeutics of surgical dentistry" (Soloviev M.).

INN: Articaine, Epinephrine

Manufacturer: 3M Deutschland GmbH

Anatomical-therapeutic-chemical classification: Articaine in combination with other drugs

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 016460

Registration period: 14.10.2015 - 14.10.2020

Instruction

Tradename

UbistezinTM ()

International proprietary name

Dosage form

Solution for submucosal injections in dentistry 4% 1.7 ml

Composition

1 ml of solution contains

active substances : articaine hydrochloride 40 mg

epinephrine hydrochloride 0.006 mg,

Excipients: sodium sulfite (equivalent to 0.31 mg SO2), hydrochloric acid (hydrochloric) 14%, sodium hydroxide solution 9%, sodium chloride, water for injection.

Description

Colorless, transparent, non-opalescent solution.

Pharmacotherapeutic group

Anesthetics. Local anesthetics. Amides. Articaine in combination with other drugs.

ATX code N01BB58

Pharmacological properties

Pharmacokinetics

Ubistezin is absorbed quickly and almost completely.

The maximum plasma level of articaine after intraoral injection is reached after approximately 10-15 minutes. The volume of distribution is 1.67 l/kg, the half-life is approximately 20 minutes and Tmax is approximately 10-15 minutes.

Articaine binds up to 95% to plasma proteins.

Articaine is rapidly hydrolyzed by plasma cholinesterases to the primary metabolite, articaic acid, which is further metabolized to articaic acid glucuronide. Articaine and its metabolites are excreted in the urine.

Epinephrine is rapidly catabolized in the liver and other tissues. Metabolites are excreted through the kidneys.

Pharmacodynamics

Ubistezin is a combined drug for local anesthesia in dentistry. Contains articaine, which is an anesthetic local action amide type and epinephrine - an adrenergic agonist that increases the duration of action of local anesthetics. Articaine leads to a reversible inhibition of the sensitivity of autonomic, sensory and motor nerve fibers. The mechanism of action of articaine is to block voltage-gated sodium channels on the nerve fiber membrane. Epinephrine leads to local vasoconstriction, resulting in a higher concentration of local anesthetic at the injection site for a long time, as well as a decrease in the likelihood of common unwanted side effects.

This drug is characterized by a low level of toxicity.

The action of the drug begins quickly (in 1 - 3 minutes after the injection). The drug provides a reliable anesthetic effect, is well tolerated. The duration of action of Ubistezin during pulp anesthesia is at least 45 minutes, and during soft tissue anesthesia - 120-240 minutes.

This drug provides a reliable analgesic effect.

Wound healing occurs without any complications, due to good tissue tolerance and minimal vasoconstriction. Due to the low concentration of epinephrine in the drug, its effect on the cardiovascular system is weak: there is no increase in blood pressure and an increase in heart rate.

Indications for use

Infiltration and conduction anesthesia in dentistry:

uncomplicated single and consecutive tooth extractions

preparation of carious cavities and preparation of the tooth stump before prosthetics

incisions and sutures in the palate

Dosage and administration

Whenever possible, the smallest volume of solution that promotes effective anesthesia should be used.

To extract upper teeth in most cases, infiltration anesthesia using 1.7 ml of Ubistezin per tooth is sufficient; in this way, painful palatal injections can be dispensed with. In the case of sequential removal of adjacent teeth, it is often possible to reduce injections.

For anesthesia for incisions or sutures in the palate shows about 0.1 ml of the drug per injection.

With a simple removal of premolars of the lower jaw , sufficient is infiltration anesthesia using 1.7 ml of Ubistezin per one tooth; in some cases, an additional injection into the submucosal region of the transitional fold may be required in an amount of 1 to 1.7 ml of the drug.

Mandibular anesthesia is indicated in rare cases. 1.7 ml of Ubistezin is sufficient.

When preparing a carious cavity and preparing a tooth stump for an artificial crown, injections from the vestibular side in the amount 0.5-1.7 ml Ubistezina for one tooth.

In the treatment of mandibular premolars conduction anesthesia should be used. 1.7 ml of Ubistezin is sufficient.

For children weighing 20-30 kg, a dose of 0.25-1 ml is sufficient; for children weighing 30 - 45 kg - doses of 0.5 - 2 ml.

Ubistezin should not be used in children under 4 years of age.

In elderly patients, due to reduced metabolic processes and a lower volume of distribution, elevated plasma levels of Ubistezin may occur.

The risk of accumulation of Ubistezin increases after repeated use (eg, repeated injection). A similar effect can be observed with a deterioration in the general condition of the patient, as well as with severe violations of the liver and kidneys (see "Special Instructions"). Thus, in all such cases, a lower dose of the drug is recommended (the minimum amount for a sufficient depth of anesthesia).

The dose of Ubistezin should be reduced in patients suffering from angina pectoris and atherosclerosis.

adults

For adults, the maximum dose is 500 mg of articaine (7 mg / kg of body weight), which is equivalent to 12.5 ml of Ubistezin, respectively - 7 cartridges.

Children

The amount of the drug to be administered should be determined by the age and body weight of the child, as well as the extent of the operation. Do not exceed the equivalent of 7 mg articaine/kg (0.175 ml Ubistezin/kg) body weight.

The drug is intended for injection as a local anesthetic for dental purposes.

In order to exclude the possibility of intravascular injection, it is always necessary to use aspiration control in two projections (with a rotation of the needle by 180 °), although its negative result does not always rule out unintentional or unnoticed intravascular injection.

The injection rate should not exceed 0.5 ml in 15 seconds, i.e. 1 cartridge per minute.

Major systemic reactions resulting from accidental intravascular injection can in most cases be avoided by using the following administration technique - after aspiration control, slowly inject 0.1-0.2 ml and not earlier than 20-30 seconds later, slowly inject the rest of the solution.

Opened cartridges should not be used on other patients.

The rest must be liquidated.

Side effects

Side effects may occur as a result of overdose, being caused by accidental intravascular administration or abnormal absorption, for example, in inflamed or vascularized tissues, and manifest themselves as symptoms of disorders of the central nervous system and / or cardiovascular system.

This drug is usually well tolerated by patients, but the following side effects may develop:

Bradycardia, heart failure

Arterial hypotension

Asystole, cardiac arrest

Metallic taste in the mouth

Noise in ears

Dizziness, headache

Nausea, vomiting

Restlessness, irritability, hyperventilation

Drowsiness, tremor, nystagmus, logorrhea (verbal excitement), muscle tremor and tonic-clonic seizures

Paresthesia of lips and/or tongue

Tachypnea

Bradypnea, which can lead to sleep apnea

Respiratory paralysis

Very rarely (< 0,01 %)

- allergic reactions

Possible manifestation of hypersensitivity to articaine in the form of rashes, swelling, itching, redness of the skin, urticaria, angioedema, conjunctivitis, rhinitis, bronchospasm or anaphylactic shock. Patients with bronchial asthma may experience nausea and diarrhea. Cross-sensitivity to articaine has been reported in patients with a delayed allergic reaction to prilocaine.

For patients with severe hypersensitivity to articaine or other amides, the use of local anesthetics of ester groups is recommended for subsequent procedures.

In patients with asymptomatic methemoglobinemia, the administration of large doses of articaine may cause clinical manifestations.

Seldom (> 0,01 %)

feeling hot

sweating

migraine-like headache

Increase in blood pressure

Pain behind the sternum

Tachycardia

Tachyarrhythmia, cardiovascular failure

Heart failure

Acute swelling of the thyroid gland

Very rarely (< 0,01 %)

- allergic reactions

allergic reactions or hypersensitivity in patients with bronchial asthma manifest as bronchospasm, acute asthma attack, loss of consciousness or shock, vomiting, diarrhea.

The possibility of delayed development of facial paralysis within 2 weeks from the moment of drug administration is not excluded. There is evidence that this phenomenon may occur after 6 months.

Local reactions: swelling and inflammation at the injection site.

Contraindications

Hypersensitivity to any of the active and auxiliary components of the drug

Due to the presence of articaine, Ubistezin is not approved for use in the following cases

hypersensitivity to local anesthetics of the amide type

severe violations of the transmission of nerve impulses and conduction of the heart (for example: AV block II and III degree, severe bradycardia)

acute heart failure in the stage of decompensation

severe arterial hypotension

in patients with cholinesterase deficiency

hemorrhagic diathesis (especially during conduction anesthesia)

injections into the inflamed area

Due to the presence of epinephrine as a vasoconstrictor component, Ubistezin is not allowed for use in the following cases

Unstable angina

Recent myocardial infarction

Recent coronary artery bypass surgery

Refractory arrhythmia

Paroxysmal tachycardia or persistent arrhythmia with a high heart rate

Untreated or uncontrolled severe hypertension

Untreated or uncontrolled congestive heart failure

Concomitant therapy with monoamine oxidase (MAO) inhibitors or tricyclic antidepressants

Due to the presence of sulfite in the composition of sodium as an auxiliary substance, Ubistezin is not allowed for use in the following cases

Hypersensitivity to sodium sulfite

Severe form of bronchial asthma

Drug Interactions

The sympathomimic effect of epinephrine may be enhanced while taking monoamine oxidase inhibitors or tricyclic antidepressants.

Epinephrine may delay the release of insulin from the pancreas and thus reduce the effect of oral antidiabetic agents.

Concomitant use of non-cardioselective beta-blockers may lead to an increase in blood pressure due to the epinephrine content of Ubistezin.

Some inhaled drugs, such as halothane, can increase the sensitivity of the myocardium to catecholamines, leading to arrhythmias during the use of Ubistezin.

special instructions

Do not use intravenously! To avoid intravascular injection, an aspiration test should be performed by monitoring tissue resistance to the injected solution. Injection pressure should match the density of the tissue.

Do not inject into the inflamed area.

Eating is possible only after the restoration of sensitivity.

Do not use opened cartridges for other patients

Do not use damaged cartridges.

Ubistezin should be used with extreme caution in cases of

angina pectoris

atherosclerosis

a significant deterioration in blood coagulation

thyrotoxicosis

narrow angle glaucoma

diabetes

lung diseases - especially bronchial asthma

pheochromocytoma

epilepsy

arterial hypertension

intraventricular and artioventricular block I degree, chronic heart failure

liver failure

kidney failure

concomitant use of phenothiazine, cardioselective beta-blockers, anticoagulants and antiplatelet agents

severe general condition, debilitated patients

old age.

It is not recommended to use Ubistezin during the treatment of patients with allergic reactions to sulfites, as well as during the treatment of patients suffering from severe bronchial asthma. The use of Ubistezin may lead to allergic reactions with anaphylactic symptoms (for example: bronchospasm).

Accidental intravascular administration of the drug may be accompanied by convulsions, followed by inhibition of the activity of the central nervous system or cardiac arrest. If these symptoms occur, immediate resuscitation is necessary with the use of resuscitation equipment, oxygen and other resuscitative medicines.

Since local anesthetics of the amide type are also metabolized by the liver, Ubistezin should be used with caution in patients with liver disease, as the risk of developing toxic plasma concentrations of the drug is increased.

Ubistezin should be used with caution in the treatment of patients with impaired cardiovascular activity, since such patients may experience a decrease in the ability to compensate for functional changes associated with a slowdown in atrioventricular conduction caused by the drug.

The drug should be used with caution in the treatment of patients with a history of epilepsy.

There is a possibility of positive results when conducting doping tests in athletes.

It must be taken into account that during treatment with inhibitors of blood coagulation and aggregation, accidental intravascular administration of a local anesthetic can lead to serious bleeding.

Accidental intravascular injections should be avoided (see Section "Method of administration and dosage")

When preparing a carious cavity for a crown, epinephrine leads to a decrease in blood flow in the pulp tissue, which leads to an increased risk of opening the tooth pulp.

When using a local anesthetic, the following medicines / therapeutic measures should be available to the doctor:

Anticonvulsants (eg, benzodiazepines or barbiturates), muscle relaxants, atropine and vasopressors, or epinephrine for severe allergic and anaphylactic reactions.

Resuscitation equipment (especially an oxygen source) that provides the possibility of artificial ventilation of the lungs if necessary.

Careful and constant monitoring of the main indicators of the state of the central nervous system, cardiovascular and respiratory systems of the patient after each injection of local anesthetic. Agitation, restlessness, tinnitus, dizziness, blackouts, tremors, depression, or drowsiness may be early warning signs of CNS toxicity (see Overdose section).

Phenothiazines may reduce the pressor effect of epinephrine. The simultaneous use of such drugs should be avoided. In cases where concomitant therapy is necessary, ensure close monitoring of the patient.

The concomitant use of non-cardioselective beta-blockers may lead to an increase in blood pressure due to the content of epinephrine. (see section "Drug Interactions").

Pregnancy and lactation

Pregnancy

There are no sufficient clinical data on the use of the drug by women during pregnancy and lactation. When using articaine during pregnancy, no adverse effects on fetal development have been established. This medicinal product should be used during pregnancy only if absolutely necessary, when the expected benefit to the mother outweighs the potential risk to the fetus.

lactation period

There are insufficient data on the excretion of articaine and its metabolites into breast milk. However, preclinical data indicate that the concentration of articaine in breast milk does not reach a clinically significant value. In this regard, after anesthesia with the use of Ubistezin, it is necessary to express the first portion of breast milk, do not use expressed milk for feeding.

Features of the influence of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

In special tests, there was no clear effect of the drug on the concentration of attention and the speed of motor reactions. However, due to the fact that the patient's preoperative anxiety and stress caused by surgery can affect the efficiency of activity, the issue of allowing the patient to drive a vehicle or work with potentially dangerous mechanisms is decided by the doctor individually in each specific case.

Overdose

Symptoms: may occur immediately upon accidental intravascular injection or under abnormal absorption conditions (eg, inflamed or vascularized tissue) and later, and manifest as central nervous system and/or vascular symptoms.

Symptoms caused by the action of articaine: manifest as symptoms of central nervous system dysfunction (metallic taste in the mouth, tinnitus, dizziness, nausea, vomiting, agitation, anxiety, increased respiratory rate, drowsiness, confusion, tremor, muscle twitching, tonic-clonic convulsions, coma and respiratory paralysis) and / or vascular symptoms (drop in blood pressure, conduction disturbances of cardiac impulses, bradycardia, cardiac arrest.

Symptoms caused by the action of epinephrine: manifest as symptoms of dysfunction of the cardiovascular system (feeling hot, sweating, migraine headache, increased blood pressure, chest pain, tachycardia, tachyarrhythmia and cardiac arrest).

The simultaneous occurrence of various complications and side effects may be the result of the mutual influence of the components of the drug on the clinical picture.

Treatment: in case of side effects, immediately stop the introduction of local anesthetic.

Basic general measures

Diagnostics (breathing, blood circulation, consciousness), maintenance/restoration of vital functions of respiration and blood circulation, oxygen administration, intravenous access.

Special Measures

hypertension : elevate the upper body of the patient, if necessary, give nifedipine sublingually.

Convulsions: protect the patient from concomitant bruising, if necessary, diazepam IV.

Hypotension: horizontal position of the patient's body, if necessary, intravascular infusion of electrolyte solutions, vasopressors (for example, epinephrine IV).

Bradycardia : atropine i.v.

Anaphylactic shock: contact an emergency physician. In the meantime, put the patient in a horizontal position, raise the lower body, intensive infusion of electrolyte solutions, if necessary - epinephrine in / in, glucocorticoid in / in.

International name

Group affiliation

Dosage form

pharmachologic effect

Combined remedy, the action of which is due to its constituent components; has a local anesthetic effect. Epinephrine, causing vasoconstriction at the injection site, makes it difficult to absorb and prolongs the action.

The onset of the effect is 0.5-3 minutes, the duration of action is 45 minutes.

Indications

Contraindications

Hypersensitivity, B12-deficiency anemia, methemoglobinemia, paroxysmal ventricular tachycardia, atrial fibrillation, angle-closure glaucoma, hypoxia, intolerance to sulfonic groups (especially in bronchial asthma). With caution. Cholinesterase deficiency, renal failure, bronchial asthma, diabetes mellitus, thyrotoxicosis, arterial hypertension, childhood(up to 4 years - efficacy and safety have not been determined).

During paracerebral blockade - preeclampsia, bleeding in the last trimester, amnionitis.

Side effects

From the side of the central nervous system (depending on the size of the applied dose): headache, impaired consciousness (up to loss of it); respiratory disorders (up to apnea); tremor, muscle twitching, convulsions.

On the part of the digestive system: nausea, vomiting, diarrhea.

On the part of the sense organ: rarely - transient visual impairment (up to blindness), diplopia.

From the CCC: lowering blood pressure, tachycardia, bradycardia, arrhythmia.

Allergic reactions: hyperemia and itching of the skin, conjunctivitis, rhinitis, angioedema of varying severity (including swelling of the upper and / or lower lip and / or cheeks, glottis with difficulty in swallowing, urticaria, difficulty breathing), anaphylactic shock.

Local reactions: swelling or inflammation at the injection site, the appearance of ischemic zones at the injection site (up to the development of tissue necrosis - with accidental intravascular injection); nerve damage (up to the development of paralysis) - occurs only if the injection technique is violated.

Application and dosage

Infiltration anesthesia: tonsillectomy (for each tonsil) - 5-10 ml; reduction of fractures - 5-20 ml; perineal suture - 5-15 ml.

Conduction anesthesia: anesthesia according to Oberst - 2-4 ml, retrobulbar - 1-2 ml, intercostal - 2-4 ml (for each segment), paravertebral - 5-10 ml, epidural (epidural) - 10-30 ml, sacral - 10-30 ml, blockade trigeminal nerve- 1-5 ml, blockade of the stellate ganglion - 5-10 ml, blockade of the brachial plexus - 10-30 ml (supraclavicular or axillary access), blockade of the external genital organs - 7-10 ml (on each side), paracervical blockade - 6- 10 ml (per side).

In case of uncomplicated extraction of the teeth of the upper jaw in the non-inflammatory stage, it is injected under the mucous membrane in the region of the transitional fold - vestibular depot 1.7 ml per tooth, if necessary - an additional 1-1.7 ml; palatal incision or suture - palatal depot 0.1 ml.

When removing the premolars of the lower jaw (5-5) in the uncomplicated stage, infiltration anesthesia gives the effect of conduction anesthesia.

When preparing cavities and turning teeth for crowns, with the exception of the molars of the lower jaw, a vestibular injection of 0.5-1.7 ml per tooth. The maximum dose is 7 mg/kg.

special instructions

Do not enter in / in! An aspiration test should be performed to avoid intravascular injection. The injection pressure should be appropriate to the sensitivity of the tissue.

Do not inject into the inflamed area.

Eating is possible only after the restoration of sensitivity.

To prevent infection (including viral hepatitis), it is necessary to always use new sterile syringes and needles every time a solution is taken from vials or ampoules. Opened cartridges must not be used again for other patients (risk of hepatitis). Do not use a damaged cartridge.

On the label of the reusable vial, the time of the first intake of the solution should be noted. Opened vials should be stored according to instructions and used within 2 days.

It does not have a harmful effect on the fetus (with the exception of possible bradycardia) with any application technique and dosage.

The possibility of admission of the patient to the management of transport drugs or to engage in activities that require a high mental and motor response is determined by the doctor.

Interaction

Tricyclic antidepressants, MAO inhibitors increase the hypertensive effect.

The local anesthetic effect of articaine is enhanced and lengthened by vasoconstrictor drugs.

Non-selective beta-blockers increase the risk of developing a hypertensive crisis and severe bradycardia.

Reviews about the medicine Ubistezin: 0

Write your review

Registration number:

Brand name of the drug: UBISTESIN

Dosage form:
Solution for injection (with epinephrine)

Composition
1 ml contains:
active substances: articaine hydrochloride 40 mg, epinephrine hydrochloride 0,006 mg (equivalent to 0.005 mg epinephrine)
Excipients: water for injection, sodium sulfite (equivalent to 0 31 mg SO2), sodium chloride.

Description
Clear, colorless liquid.

Pharmacotherapeutic group
Local anesthetic + vasoconstrictor

ATX code: N018858

pharmachologic effect
Ubistezin is a combined drug for local anesthesia in dentistry. Articaine, which is part of it, is a local anesthetic of the amide type of the thiafene group. The action of the drug begins quickly - after 1-3 minutes. The duration of anesthesia is at least 45 minutes. Wound healing proceeds without complications due to good tissue tolerance and minimal vasoconstrictive effect. Due to the low content of epinephrine in the preparation, its effect on the cardiovascular system is little expressed: there is almost no increase in blood pressure and an increase in heart rate.
Pharmacokinetics. Articaine with submucosal administration in the oral cavity has a high diffuse ability. Communication with proteins is 95%. Active substances penetrate the placental barrier to a minimal extent, are practically not excreted with breast milk, the half-life is 25 minutes.

Indications for use
Infiltration and conduction anesthesia in dentistry (especially in patients with concomitant severe somatic diseases), including during the following manipulations: