Articaine and neurotoxicity – a review

Key Points Discusses articaine which is a local anaesthetic differing in chemical structure from the other amide anaesthetics and generally used in higher concentrations. Notes that several retrospective studies suggest a higher risk of paraesthesia after administration of articaine at a concentration of 4 % when compared to other anaesthetics used at lower concentrations. Highlights that in animal studies and in cell culture experiments articaine did not have a higher toxicity compared to other amide-anaesthetics. The biochemical composition of articaine differs from other amide anaesthetics. The lipophilic part of articaine consists of a thiophene ring, whereas other amide anaesthetics contain a benzene ring. When used correctly, local anaesthetics are remarkably safe. However, all local anaesthetics are potentially neurotoxic. In rare cases a prolonged abnormal perception/sensation may be present after the expected duration of action (paraesthesia). In several countries retrospective studies have been conducted that examined the incidence of persistent paraesthesia after the use of local anaesthetics. In most studies the number of paraesthesia cases after the use of articaine was higher than the market share of this anaesthetic. In animal studies and in cell culture experiments, however, articaine did not have a higher toxicity compared to other amide anaesthetics. Further studies of the cause of paraesthesia after administration of local anaesthetics seem to be warranted.