Articaine local anaesthetic now available in Australia

Septodont has released the local anaesthetic Articaine, marketed under their brand name of Septanest, onto the Australian market through local distributors, Henry Schein Regional. Articaine is a member of the amide family and is the first new local anaesthetic to be released to dentistry in more than 35 years. Although it belongs to the amide group, it has a number of features that make it quite unique, particularly in the practice of dentistry.

Articaine was developed and released in Germany in 1976 into the field of medicine and it has been used in medicine since that time. The product, which was originally released under the name Carticaine, underwent a name change shortly after its release to Articaine.

It was not broadly used in medicine as it very closely relates in activity to other anaesthetics currently in use. A few years following its introduction, use began in dentistry and it was discovered that in the oral cavity, there were some very distinct advantages over other commonly used anaesthetics.

Most other amide anaesthetics are metabolised primarily in the liver. This means that the average half life of these materials was about 90 minutes. Articaine (as it has an ester chain in common with the old ester type anaesthetics that underwent breakdown in blood plasma) is metabolised primarily in blood plasma as well. This shortens the half life to approximately 20 minutes. As the primary risk of amide local anaesthetics is a systemic build-up of anaesthetic levels in circulation which can have a potential for cardio-toxicity, the short half life of Articaine tends to make it considerably safer for use in the human body.

The molecular structure of Articaine is quite different than most other local anaesthetics. In place of an aromatic benzene ring, it has a thiophene ring. This changes both the structure and size of the molecule. Because of this ring, Articaine is both highly lipophilic and hydrophilic. It has an ability to move through tissue more effectively than other local anaesthetics. Its movement through hard tissue and soft tissue such as nerve membranes is significant and anaesthesia is produced where sometimes other materials fail. Frequently, operators report an increase in the success of nerve blocks and anaesthesia, even in the presence of infected tissue.

As a result of this, it appears to produce deeper and more prolonged anaesthesia with lower levels of vasoconstrictor. The penetration of bone is more effective which results frequently in effective anaesthesia of the mandibular jaw by infiltration rather than nerve block. It has been shown to be very effective in the anaesthesia of posterior molar teeth in the maxilla and on occasion where extraction is desired, it has not been necessary to carry out a palatal injection.

It appears to be because of the length of anaesthesia, which is usually 60+ minutes and the reported depth of anaesthesia, an ideal anaesthetic for use in oral surgery or in implant surgery.

The level of vasoconstrictor, which is 1:100,000 adrenaline, provides all the haemostasis that may be desired.

The product itself now has very widespread usage and there is a large body of literature available. According to the company, following its release in the United States just over three years ago, it is now used in 30-35% of all dental anaesthesia.

Articaine is packaged in cartridges of 2.2ml articaine 4%, adrenaline 1:100,000 in boxes of 50. The cartridges are neutral glass, siliconised for ease of injection and have a synthetic rubber bung and a diaphragm with synthetic rubber laminated to a totally denatured natural rubber. This means that there is no anaesthetic in contact with latex and the latex that is used has been so denatured that the risk of allergy is very substantially reduced. Septanest, manufactured in France by the Septodont Company, is now available from Henry Schein Regional.