Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure Following Maxillary Infiltration Technique

Abstract

Background: Hemodynamic responses to vasoconstrictor-containing local anesthetics are clinically relevant in endodontics, particularly for patients with cardiovascular risk. Evidence comparing 2% lidocaine (1:80,000 epinephrine) and 4% articaine (1:100,000 epinephrine) during maxillary infiltration remains mixed, with prior trials often underpowered and variably controlling for anxiety. Objective: To compare short-interval changes in blood pressure and heart rate following maxillary buccal infiltration with lidocaine versus articaine in healthy adults. Methods: In a double-blind randomized clinical trial at a single academic center (January 2024–May 2025), 160 ASA I participants (18–60 years) undergoing non-surgical root canal therapy were randomized to receive 1.8 mL lidocaine or articaine. Anxiety was screened using the Modified Dental Anxiety Scale; only low-anxiety participants were included. Systolic and diastolic blood pressure and heart rate were measured after a 15-minute rest (baseline) and 10 minutes post-injection. Within-group changes used paired t-tests; between-group comparisons used independent t-tests with 95% CIs and effect sizes. Results: Lidocaine produced minimal changes (systolic +0.51 mmHg, p=0.014; diastolic +0.27 mmHg, p=0.124; heart rate +0.68 bpm, p=0.003). Articaine increased systolic and diastolic pressures by +4.41 and +3.30 mmHg, respectively (both p<0.001), and heart rate by +2.76 bpm (p<0.001). At 10 minutes, articaine exceeded lidocaine for systolic (+2.33 mmHg, 95% CI +0.64 to +4.02; p=0.006) and diastolic (+1.91 mmHg, 95% CI +0.59 to +3.23; p=0.003) pressures; heart rate difference was not significant (+1.57 bpm; p=0.064). Conclusion: Both agents were hemodynamically safe in healthy adults; articaine produced small but statistically greater pressor effects. Lidocaine may be preferred when minimizing circulatory changes is prioritized.