Changes in glycemic level following injection of local anaesthesia with epinephrine in hypertensive patients

Background: Stress hormones or sympathetic activities induce hemodynamic changes and increase peripheral vasoconstriction, making more blood available in the body's vital organs. Hepatic cells will respond by increasing glucose release and gluconeogenesis. All these events inhibit glucose uptake by peripheral tissues and induce hyperglycemia. As such, more sugar becomes available in the blood. Injection of local anaesthesia and dental extraction are considered stressful procedures. Moreover, epinephrine added to the local anaesthesia, which is used as a vasoconstrictor, can produce hyperglycemia during dental procedures. This study aimed to evaluate changes in the glycemic level of patients with controlled hypertension and compare it with healthy adults undergoing simple tooth extraction under local anaesthesia with epinephrine 1:100,000. Methods: A prospective clinical study was conducted on 60 normotensive and 60 controlled hypertensive patients. Glycemic level was monitored at two different time points (before and 25 minutes after infiltration of local anaesthesia). Each patient was provided with one cartridge of anesthetic solution containing lignocaine 2% and epinephrine (1:100,000). Results: The glycemic level did not significantly change in the normotensive group (p=0.372) and significantly increased in the hypertensive group (p=0.018). The difference between the two groups was significant (p=0.017). Conclusion: Significant elevation in glycemic level was seen when dealing with controlled hypertensive patients. In patients with normal blood pressure, their glycemic level did not increase during simple extraction under one carpule of local anaesthesia with a vasoconstrictor.