Physiology of pregnancy and oral local anesthesia considerations

Xueer Zhou; Yunyu Zhong; Zijian Pan; Jiankang Zhang; Jian Pan

doi:10.7717/peerj.15585

Physiology of pregnancy and oral local anesthesia considerations

PeerJ. 2023 Jun 29:11:e15585. doi: 10.7717/peerj.15585. eCollection 2023.

Authors

Xueer Zhou^#^{1

2}, Yunyu Zhong^#^{1

2}, Zijian Pan^{1

2}, Jiankang Zhang^{1

2

3}, Jian Pan^{1

2

3}

Affiliations

¹ State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
² National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
³ Chengdu Advanced Medical Science Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.

^# Contributed equally.

Abstract

Background: Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients.

Methodology: An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment.

Results: Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied.

Conclusions: Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

Keywords: Local anesthesia; Oral treatments; Physiology of pregnancy.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Anesthesia, Local*
Anesthetics, Local* / adverse effects
Epinephrine
Female
Humans
Lidocaine
Pain / chemically induced
Pregnancy

Substances

Anesthetics, Local
Lidocaine
Epinephrine

Grants and funding

This work was supported by the project of the Research and Develop Program, West China Hospital of Stomatology Sichuan University (LCYJ 2019-1), the Science and Technology Project of the Health Planning Committee of Sichuan (21PJ062), and the Natural Science Foundation of Sichuan Province (2022NSFSC1462). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.