Effect of Local Anesthesia with and without Adrenaline on Blood Glucose Concentration, Blood Pressure, and Pulse Rate in Patients Undergoing Tooth Extractions: A Comparative Study

Abstract

Background:

Local anesthesia is a fundamental component of dental procedures, particularly tooth extractions. The addition of adrenaline to local anesthetic solutions enhances anesthetic efficacy and prolongs its action, but may induce systemic changes, especially in blood pressure, pulse rate, and blood glucose levels. Understanding these physiological effects is critical to ensuring patient safety, particularly in individuals with cardiovascular or metabolic concerns.

Aim:

The aim of this study was to compare the effects of local anesthesia with and without adrenaline on blood glucose concentration, blood pressure, and pulse rate in patients undergoing tooth extractions.

Materials and Methods:

A prospective, comparative clinical study was conducted over 5 months on 110 patients requiring tooth extraction. Patients were randomly allocated into two groups: Group A received lignocaine 2% with adrenaline (1:80,000) and Group B received lignocaine 2% plain solution. Blood glucose levels, systolic and diastolic blood pressure, and pulse rate were recorded at three intervals: preanesthesia, 10 min postanesthesia, and immediately postextraction. The data were analyzed using SPSS version 25.0, with statistical significance set at P < 0.05.

Results:

The demographic characteristics were comparable between both the groups. Group A exhibited significant increases in systolic blood pressure (138.20 ± 10.45 mmHg), diastolic blood pressure (87.10 ± 8.15 mmHg), blood glucose levels (112.85 ± 12.34 mg/dL), and pulse rate (88.40 ± 7.20 bpm) compared to Group B (126.75 ± 8.45 mmHg, 79.85 ± 7.10 mmHg, 101.90 ± 10.55 mg/dL, and 78.45 ± 6.10 bpm, respectively) postextraction (P < 0.001). Percentage changes from baseline were significantly higher in Group A across all parameters.

Conclusion:

The present study demonstrates that the use of adrenaline-containing local anesthesia during tooth extractions should have a cautious approach when dealing with patients. While the technique is effective for achieving hemostasis and prolonged anesthetic action, caution is advised, particularly in elderly or medically compromised patients. Careful patient selection and continuous monitoring are essential to minimize potential complications.

INTRODUCTION

Tooth extraction is one of the most common minor oral surgical procedures performed in dental practice. It is usually indicated for teeth that are nonrestorable, extensively decayed, or impacted. The success of this procedure relies heavily on effective pain control, which is most commonly achieved through the administration of local anesthesia. Local anesthetic agents not only eliminate pain but also provide sufficient time and comfort for both the patient and the clinician to perform the procedure efficiently.[1]

The advent of modern local anesthetic techniques has significantly improved patient outcomes and has made dental extractions a routine and safe procedure.[1] However, the administration of local anesthesia is not without its systemic implications, particularly when vasoconstrictors like adrenaline are used as additives.[2] The primary role of adrenaline in local anesthetic solutions is to prolong the duration of anesthesia, reduce intraoperative bleeding, and slow systemic absorption of the anesthetic agent, thereby minimizing toxicity.[3] While these benefits are clinically valuable, adrenaline’s sympathomimetic activity can result in significant cardiovascular changes, such as elevated blood pressure, increased pulse rate, and altered glucose metabolism.[4]

It is well understood that adrenaline stimulates both alpha- and beta-adrenergic receptors, which can lead to vasoconstriction and an increase in cardiac output.[5] These effects, while usually transient, can pose a risk to certain patient populations, particularly those with underlying cardiovascular diseases or diabetes.[5] The use of local anesthesia with adrenaline in medically compromised patients remains a topic of considerable debate. In such individuals, even small amounts of adrenaline can potentially lead to prolonged increases in blood pressure, tachycardia, and disturbances in blood glucose regulation.[6] Dental professionals must, therefore, weigh the benefits of using adrenaline against its potential systemic risks in sensitive patients.

Several clinical studies have explored the impact of local anesthesia, with and without adrenaline, on hemodynamic and metabolic parameters.[6] In particular, there is growing interest in assessing how local anesthesia influences blood pressure, pulse rate, and blood glucose levels during routine dental extractions.[7] It is known that the stress and anxiety associated with dental procedures can independently elevate these physiological parameters, which may further be exacerbated by the pharmacological effects of adrenaline.[8] Understanding whether these changes are primarily stress-induced or adrenaline-mediated is crucial for determining safe anesthetic protocols for various patient groups.

Earlier studies have shown that adrenaline-containing local anesthesia can cause transient elevations in the blood pressure and pulse rate. These cardiovascular responses can persist for several minutes postadministration and may require clinical monitoring in susceptible patients.[7] In addition, adrenaline has been shown to influence blood glucose levels by promoting glycogenolysis and gluconeogenesis, mechanisms that are particularly relevant in diabetic patients where glycemic control is critical.[8] The increase in blood glucose concentration following the administration of local anesthesia with adrenaline raises concerns about the safety of its routine use, especially in patients with impaired glucose metabolism.[9]

Conversely, studies utilizing plain local anesthetic agents, without vasoconstrictors, have demonstrated minimal systemic effects.[6] The absence of adrenaline in such cases reduces the likelihood of hemodynamic fluctuations and metabolic disturbances, making plain local anesthesia a safer alternative for high-risk patient groups.[5] However, plain local anesthetics have the drawback of a shorter duration of action and may not provide the same level of intraoperative hemostasis or postoperative comfort.[4] This trade-off between safety and anesthetic efficacy is an important clinical consideration that warrants further investigation.

Pain control during dental extractions is a fundamental patient right and an essential component of modern dentistry.[3] For this reason, dental practitioners frequently rely on adrenaline-containing local anesthetic solutions to achieve profound and long-lasting anesthesia.[1] Nevertheless, given the systemic effects associated with adrenaline, it is imperative to determine whether its use significantly alters key physiological parameters, such as blood glucose concentration, blood pressure, and pulse rate.[8] Understanding these effects can help clinicians make informed decisions regarding anesthetic selection based on individual patient profiles and associated risk factors.

Moreover, the psychological response to dental treatment, often referred to as dental anxiety, has been shown to independently trigger sympathetic nervous system activation, leading to elevated cardiovascular parameters.[9] It is essential to differentiate between anxiety-induced physiological changes and those directly resulting from the pharmacological action of adrenaline to appropriately manage patient care during dental extractions.[10] Anxiety management strategies, patient counseling, and pharmacological considerations must all be integrated into a comprehensive treatment plan to ensure safety and effectiveness.

Sample size calculation

The sample size determination was done by:

n = (Zα + Zβ) ² × 2S²

(X₁ − X₂) ²

By maintaining a significance level of 5% and a test power of 80%, the critical value for a two-tailed test at a 5% significance level is Zα =1.96, whereas the critical value for a one-tailed test at an 80% power level is Zβ =0.84.

MATERIALS AND METHODS

This study was a prospective, comparative clinical investigation to assess the effect of local anesthesia with and without adrenaline on blood glucose concentration, blood pressure, and pulse rate in patients undergoing tooth extractions. In the present study all the assessments and recording of the study findings were carried out by study coordinator under the direct supervision and ultimate responsibility of the principal investigator. The study was conducted from February to June 2025 at Siddharth Multi Speciality Dental Hospital, Vijayawada, Andhra Pradesh. The study was evaluated and approved, and an ethical clearance was obtained from the Institutional Ethics Committee (SMSDH/2024/15). All participants were thoroughly informed about the nature of the study, and written informed consent was obtained from each patient before their inclusion in the study in patient’s native language.

A total of 110 patients requiring tooth extraction were included in the study. The sample size was calculated based on previous studies and power analysis to ensure the detection of statistically significant differences in hemodynamic and glycemic parameters between the study groups. Patients included in the study were aged between 18 and 60 years, required simple tooth extraction under local anesthesia, and were classified as per the American Society of Anesthesiologists physical status I or II. Only patients with fasting blood glucose levels within normal limits or controlled diabetes mellitus (fasting blood glucose < 140 mg/dL) were considered eligible and were included in the study. Furthermore, participation was restricted to those who voluntarily agreed and provided written informed consent. Patients were excluded from the study if they were medically compromised with uncontrolled systemic conditions, taking medications known to affect glucose metabolism such as corticosteroids or beta-blockers, pregnant or lactating, allergic to local anesthetics or adrenaline, or if they required surgical or complicated extractions.

Inclusion criteria

• Patient should have medically managed blood sugar levels and blood pressure

• Age of patients: aged between 18 and 60 years

• Subjects should have no known allergies to local anesthetics or any specific contraindications to adrenaline

• The patient is awake and alert

• The ability to use language and food normally. Participants must be candidates for the specific local anesthetic agent being used in the study (commonly lignocaine/lidocaine)

Exclusion criteria

• Individuals afflicted with any other systemic disease or condition

• Individuals who had a personal or familial history of mental illness

• Patients not willing to participate in the study. Subjects with history of known allergies to local anesthetics or any specific contraindications to adrenaline.

Group allocation

Following the initial screening and eligibility assessment, patients were randomly allocated into two groups, with 55 patients in each group. Group A consisted of patients who received local anesthesia with adrenaline (lignocaine 2% with adrenaline in a concentration of 1:80,000), whereas Group B comprised patients who received plain local anesthesia (lignocaine 2% without adrenaline). Randomization was achieved through the use of a computer-generated random number table to eliminate selection bias and ensure balanced group distribution.

The materials required for the study included lignocaine 2% with adrenaline 1:80,000, lignocaine 2% plain solution, a digital sphygmomanometer for recording blood pressure, a pulse oximeter for monitoring pulse rate, and a glucometer with standardized calibration for capillary blood glucose measurement. In addition, disposable syringes, needles, and standard dental extraction instruments were utilized for all procedures.

Procedure

A qualified healthcare provider was appointed for taking care of the patient during the study. period and follow was also done by contacting the patient through telephonic conversation. All patients underwent a standardized treatment protocol to ensure uniformity in clinical management. During the preoperative assessment, a detailed medical and dental history was recorded for each patient. Baseline fasting blood glucose levels were measured using a calibrated glucometer, while baseline systolic and diastolic blood pressure levels, along with pulse rate, were recorded after allowing the patient to rest in a seated position for at least 10 min to eliminate any stress-induced variability. Local anesthesia was administered according to the group allocation. Patients in Group A received lignocaine 2% with adrenaline 1:80,000, whereas those in Group B were administered lignocaine 2% plain solution. The total volume of local anesthetic given to each patient was standardized and did not exceed 2 mL. The choice of infiltration or nerve block technique was made based on the anatomical requirement of the tooth to be extracted, following established clinical protocols. After the administration of the local anesthetic, blood glucose levels, blood pressure, and pulse rate were measured again after 10 min. Tooth extraction was performed once adequate anesthesia was achieved, and immediately following the extraction, the same parameters were recorded for the final time. All procedures were carried out by the same experienced oral surgeon to minimize operator-dependent variability. No additional sedatives or medications were administered during the study period.

Outcome measures

The primary outcome measures assessed during the study were changes in blood glucose concentration (expressed in mg/dL), systolic and diastolic blood pressure (measured in mmHg), and pulse rate (recorded in beats per minute). Each of these parameters was recorded at three distinct time intervals: prior to the administration of local anesthesia, 10 min after local anesthetic administration, and immediately after tooth extraction.

Statistical analysis

The data collected during the study were compiled and statistically analyzed using SPSS software version 25.0 was used. The software used is IBM SPSS Statistics for Windows, developed and maintained by IBM Corp. of Armonk, NY, USA. Descriptive statistics including the mean and standard deviation were calculated for all parameters in both the groups. Comparative analysis between the two groups was conducted using the independent t-test to evaluate intergroup differences, while the paired t-test was employed for intragroup comparisons of pre- and postprocedure values. P <0.05 was considered indicative of statistical significance for all tests performed.

RESULTS

In the present study, a total of 110 patients were enrolled and equally divided into two groups to compare the effects of local anesthesia with adrenaline and plain local anesthesia on various physiological parameters during tooth extractions.

Demographic characteristics

The demographic analysis of the study population revealed no statistically significant differences between Group A (patients receiving local anesthesia with adrenaline) and Group B (patients receiving plain local anesthesia). The mean age in Group A was 38.75 ± 10.15 years, while in Group B, it was 37.90 ± 9.85 years (P = 0.582), indicating a comparable age distribution. Gender distribution was nearly identical, with males accounting for 54.55% in Group A and 52.73% in Group B (P = 0.842). Similarly, female participants constituted 45.45% in Group A and 47.27% in Group B. The body mass index (BMI) showed no significant variation between the groups, with Group A recording a mean BMI of 24.30 ± 2.45 kg/m² and Group B, 24.15 ± 2.35 kg/m² (P = 0.695). Furthermore, baseline fasting blood glucose levels were comparable between the groups, with means of 98.45 ± 10.23 mg/dL in Group A and 97.80 ± 9.87 mg/dL in Group B (P = 0.612). These findings confirmed that both the groups were demographically well matched at baseline, eliminating confounding influences related to age, gender, BMI, or initial glucose levels [Table 1].

Table 1.

Demographic parameters of study population

Parameter	Group A (with adrenaline), mean±SD	Group B (without adrenaline), mean±SD	P
Age (years)	38.75±10.15	37.90±9.85	0.582
Gender, n (%)
Male	30 (54.55)	29 (52.73)	0.842
Female	25 (45.45)	26 (47.27)
BMI (kg/m²)	24.30±2.45	24.15±2.35	0.695
Fasting blood glucose (mg/dL)	98.45±10.23	97.80±9.87	0.612

SD=Standard deviation, BMI=Body mass index

Blood pressure changes

The comparison of systolic and diastolic blood pressure across different time intervals revealed significant intergroup differences following the administration of local anesthesia. At baseline (preanesthesia), there was no statistically significant difference in systolic (P = 0.587) or diastolic (P = 0.732) blood pressure between the groups. However, 10 min after the administration of local anesthetic, systolic blood pressure increased significantly in Group A to 134.90 ± 9.75 mmHg compared to 125.40 ± 8.12 mmHg in Group B (P < 0.001). Similarly, diastolic blood pressure rose to 85.25 ± 7.55 mmHg in Group A, whereas Group B recorded 79.20 ± 6.85 mmHg (P < 0.001). The trend persisted postextraction, where systolic blood pressure further increased to 138.20 ± 10.45 mmHg in Group A, significantly higher than the 126.75 ± 8.45 mmHg observed in Group B (P < 0.001). Diastolic blood pressure also showed a notable elevation postextraction, with Group A recording 87.10 ± 8.15 mmHg compared to 79.85 ± 7.10 mmHg in Group B (P < 0.001). These results demonstrate that the use of adrenaline in local anesthesia significantly elevated both systolic and diastolic blood pressure during dental procedures [Table 2].

Table 2.

Comparison of systolic and diastolic blood pressure (mmHg) between groups

Time interval	Group A systolic BP, mean±SD	Group B systolic BP, mean±SD	P	Group A diastolic BP, mean±SD	Group B diastolic BP, mean±SD	P
Preanesthesia	122.60±8.45	123.15±7.90	0.587	78.75±6.10	78.40±6.25	0.732
10 min postanesthesia	134.90±9.75	125.40±8.12	<0.001*	85.25±7.55	79.20±6.85	<0.001*
Postextraction	138.20±10.45	126.75±8.45	<0.001*	87.10±8.15	79.85±7.10	<0.001*

*Significant at P<0.05. SD=Standard deviation, BP=Blood pressure

Blood glucose levels

Blood glucose levels exhibited significant changes following local anesthetic administration. At baseline, both the groups demonstrated similar fasting blood glucose levels (Group A: 98.45 ± 10.23 mg/dL; Group B: 97.80 ± 9.87 mg/dL; P = 0.612). However, 10 min postanesthesia, blood glucose levels in Group A increased significantly to 110.30 ± 11.45 mg/dL, while Group B recorded a mean of 100.25 ± 10.12 mg/dL (P < 0.001). This upward trend was maintained postextraction, with Group A reaching 112.85 ± 12.34 mg/dL compared to 101.90 ± 10.55 mg/dL in Group B (P < 0.001). These findings indicated that the addition of adrenaline in local anesthesia results in a significant rise in blood glucose concentration, likely due to the metabolic and sympathomimetic effects of adrenaline [Table 3].

Table 3.

Comparison of blood glucose levels (mg/dL) between groups

Time interval	Group A (with adrenaline), mean±SD	Group B (without adrenaline), mean±SD	P
Preanesthesia	98.45±10.23	97.80±9.87	0.612
10 min postanesthesia	110.30±11.45	100.25±10.12	<0.001*
Postextraction	112.85±12.34	101.90±10.55	<0.001*

*Significant at P<0.05. SD=Standard deviation

Pulse rate variations

Pulse rate analysis revealed a statistically significant increase in heart rate following the administration of adrenaline-containing local anesthesia. Preanesthesia pulse rates were comparable between groups (Group A: 76.35 ± 5.80 bpm; Group B: 75.90 ± 5.65 bpm; P = 0.635). After 10 min, Group A exhibited a significant rise in pulse rate to 86.25 ± 6.75 bpm, while Group B maintained a relatively stable rate of 77.80 ± 5.90 bpm (P < 0.001). Postextraction, the pulse rate further increased in Group A to 88.40 ± 7.20 bpm, compared to 78.45 ± 6.10 bpm in Group B (P < 0.001). This demonstrated that adrenaline use contributes to a significant increase in pulse rate, reflecting heightened cardiovascular activity [Table 4].

Table 4.

Comparison of pulse rate (beats per minute) between groups

Time interval	Group A (with adrenaline), mean±SD	Group B (without adrenaline), mean±SD	P
Preanesthesia	76.35±5.80	75.90±5.65	0.635
10 min postanesthesia	86.25±6.75	77.80±5.90	<0.001*
Postextraction	88.40±7.20	78.45±6.10	<0.001*

*Significant at P<0.05. SD=Standard deviation

Percentage changes from baseline

The percentage change analysis from baseline provided further insight into the physiological impact of adrenaline. Blood glucose levels increased by 14.63% in Group A, compared to only 4.19% in Group B (P < 0.001). Systolic blood pressure increased by 12.69% in Group A, significantly higher than the 2.93% rise seen in Group B (P < 0.001). Diastolic blood pressure increased by 10.60% in Group A, while Group B demonstrated only a 1.85% rise (P < 0.001). Pulse rate experienced a substantial 15.84% increase in Group A compared to 3.36% in Group B (P < 0.001). These results clearly indicated that adrenaline significantly amplifies changes in all measured physiological parameters, whereas plain local anesthesia produces minimal alterations [Table 5].

Table 5.

Percentage change from baseline for each parameter within groups

Parameter	Group A (with adrenaline) change (%)	Group B (without adrenaline) change (%)	P
Blood glucose (postextraction)	+14.63	+4.19	<0.001*
Systolic BP (postextraction)	+12.69	+2.93	<0.001*
Diastolic BP (postextraction)	+10.60	+1.85	<0.001*
Pulse rate (postextraction)	+15.84	+3.36	<0.001*

*One asterisk means that the p-value is less than 0.05. BP=Blood pressure

Multiple regression analysis

The multiple regression analysis identified significant predictors for changes in physiological parameters postextraction. Adrenaline use emerged as the most influential factor across all outcomes. For blood glucose, adrenaline use was associated with an increase of 10.20 mg/dL (β =10.20; P < 0.001), while age, gender, and BMI had no significant impact. Similarly, adrenaline significantly predicted increases in systolic blood pressure (β =11.45; P < 0.001) and diastolic blood pressure (β =7.25; P < 0.001). Age also significantly influenced both systolic (β =0.28; P = 0.002) and diastolic (β =0.19; P = 0.008) pressures, suggesting older patients experienced greater hypertensive responses. BMI displayed borderline significance for blood pressure outcomes, but was not statistically conclusive. For pulse rate, adrenaline use was again the dominant predictor, with a β coefficient of 9.85 (P < 0.001), while age, gender, and BMI did not significantly influence heart rate changes [Table 6].

Table 6.

Multiple regression analysis for predictors of postextraction physiological changes

Dependent variable	Independent variable	β coefficient	SE	t	P	Interpretation
Postextraction blood glucose (mg/dL)	Adrenaline use (Yes=1, No=0)	10.20	1.15	8.87	<0.001*	Significant positive association
	Age (years)	0.12	0.08	1.50	0.137	Not significant
	Gender (male=1, female=0)	0.95	1.10	0.86	0.393	Not significant
	BMI (kg/m²)	0.25	0.21	1.19	0.237	Not significant
Postextraction systolic BP (mmHg)	Adrenaline use (yes=1, no=0)	11.45	1.35	8.48	<0.001*	Significant positive association
	Age (years)	0.28	0.09	3.11	0.002*	Significant positive association
	Gender (male=1, female=0)	0.85	1.20	0.71	0.477	Not significant
	BMI (kg/m²)	0.40	0.23	1.74	0.084	Borderline significance
Postextraction diastolic BP (mmHg)	Adrenaline use (yes=1, no=0)	7.25	1.05	6.90	<0.001*	Significant positive association
	Age (years)	0.19	0.07	2.71	0.008*	Significant positive association
	Gender (male=1, female=0)	0.55	0.90	0.61	0.542	Not significant
	BMI (kg/m²)	0.35	0.18	1.94	0.055	Borderline significance
Postextraction pulse rate (beats/min)	Adrenaline use (yes=1, no=0)	9.85	1.10	8.95	<0.001*	Significant positive association
	Age (years)	0.09	0.06	1.50	0.136	Not significant
	Gender (male=1, female=0)	0.65	0.85	0.76	0.451	Not significant
	BMI (kg/m²)	0.22	0.16	1.37	0.173	Not significant

*One asterisk means that the p-value is less than 0.05. BMI=Body mass index, SE=Standard error, BP=Blood pressure

DISCUSSION

In this study, both the groups demonstrated no statistically significant baseline differences in demographics, ensuring comparability. The mean age in Group A was 38.75 ± 10.15 years, and in Group B, it was 37.90 ± 9.85 years. The gender distribution was nearly identical, with males comprising 54.55% in Group A and 52.73% in Group B, while females accounted for 45.45% and 47.27% in Group B. BMI was comparable (24.30 ± 2.45 kg/m² in Group A vs. 24.15 ± 2.35 kg/m² in Group B), with baseline fasting blood glucose levels of 98.45 ± 10.23 mg/dL (Group A) and 97.80 ± 9.87 mg/dL in Group B. These findings align with the observations of Kaur et al.[11] and Ali et al.,[12] who emphasized the importance of balanced baseline characteristics to accurately interpret the physiological impact of local anesthesia with and without adrenaline.

Regarding blood pressure changes [Table 2], a significant rise in systolic and diastolic blood pressure was observed in Group A following adrenaline administration. Systolic pressure increased to 134.90 ± 9.75 mmHg postanesthesia and 138.20 ± 10.45 mmHg postextraction, compared to 125.40 ± 8.12 mmHg and 126.75 ± 8.45 mmHg in Group B, respectively. Similarly, diastolic pressure rose to 85.25 ± 7.55 mmHg and 87.10 ± 8.15 mmHg in Group A versus 79.20 ± 6.85 mmHg and 79.85 ± 7.10 mmHg in Group B. These results are consistent with Silvestre et al.,[13] who reported that adrenaline-containing anesthesia significantly elevates blood pressure during dental extractions. Furthermore, Guimaraes et al.[14] in their systematic review demonstrated a similar transient hypertensive response, with systolic pressure increases ranging from 8 to 15 mmHg, comparable to the 12.69% systolic increase observed in this study. Similarly, Moaddabi et al.[15] found that articaine with adrenaline significantly increased blood pressure postmaxillary infiltration, reinforcing the current findings.

Blood glucose levels [Table 3] showed a significant increase postadrenaline administration, with Group A recording 110.30 ± 11.45 mg/dL after 10 min and 112.85 ± 12.34 mg/dL postextraction, compared to 100.25 ± 10.12 mg/dL and 101.90 ± 10.55 mg/dL in Group B. The percentage increase in glucose was 14.63% in Group A versus 4.19% in Group B. These results align with Goel et al.,[16] who reported an average increase of 12–15 mg/dL in blood glucose following adrenaline use during extractions. Similarly, Pradeep et al.[17] found that adrenaline-containing anesthesia led to an average glucose increase of approximately 10%–15%, even in diabetic patients. Qaranizade et al.[18] also observed a postinjection glucose elevation of 10–20 mg/dL, consistent with the present study. These increases can be attributed to the metabolic effects of adrenaline, which stimulate glycogenolysis and gluconeogenesis, as described by Santos-Paul et al.[19]

Pulse rate variations [Table 4] further confirmed the sympathomimetic effects of adrenaline. Group A demonstrated a significant rise to 86.25 ± 6.75 bpm postanesthesia and 88.40 ± 7.20 bpm postextraction, compared to Group B’s 77.80 ± 5.90 bpm and 78.45 ± 6.10 bpm, respectively. The pulse rate increased by 15.84% in Group A, compared to 3.36% in Group B. These results are consistent with Salonen et al.,[20] who observed that adrenaline-containing anesthesia increased pulse rates by approximately 10%–20%. In addition, Ali et al.[12] reported a significant increase of around 10 bpm postadrenaline administration, comparable to the 12 bpm rise observed in our study.

The percentage change from baseline [Table 5] clearly highlights adrenaline’s significant impact on all physiological parameters. Blood glucose increased by 14.63%, systolic blood pressure by 12.69%, diastolic blood pressure by 10.60%, and pulse rate by 15.84% in Group A, with minimal changes in Group B. These findings are consistent with the patterns reported by Kaur et al.,[11] where adrenaline use led to approximately 12%–15% increases across hemodynamic and metabolic parameters. Similarly, Silvestre et al.[13] noted exaggerated hemodynamic responses with vasoconstrictor-enhanced anesthesia, particularly in anxious individuals or patients with underlying cardiovascular concerns.

The multiple regression analysis [Table 6] identified adrenaline use as the most significant predictor of physiological changes. Adrenaline was associated with increases of 10.20 mg/dL in blood glucose, 11.45 mmHg in systolic blood pressure, 7.25 mmHg in diastolic blood pressure, and 9.85 bpm in pulse rate. These findings align with Guimaraes et al.,[14] who emphasized adrenaline as the dominant factor influencing hemodynamic stability during dental procedures. Age was also a significant predictor for blood pressure changes, with older individuals experiencing greater hypertensive responses, consistent with the vascular aging theories discussed by Martyushev-Poklad et al.[21] BMI showed borderline significance, echoing the conclusions of Seminario-Amez et al.,[22] who suggested that cardiovascular status, rather than BMI alone, primarily determines hemodynamic responses to anesthesia.

Collectively, the present study’s results support existing evidence that adrenaline-containing local anesthesia, while effective for achieving hemostasis and prolonged anesthetic action, significantly elevates blood pressure, blood glucose levels, and pulse rate. These physiological effects, although transient, necessitate careful monitoring, especially in elderly or medically compromised patients, as recommended by Santos-Paul et al.[19] and Ali et al.[12]

Limitation of the study

1. Study should be carried on larger sample size

2. Timeline presents limitation for studying the impact of intervention

3. The money of money associated with the longitudinal research.

Key Findings of the study

The study findings highlights the fact that patient centric care improves the quality of care and quality of life in individuals with long-term conditions like diabetes, high blood pressure and cardiovascular disorders.

The study findings reveals a significant risk effect of using adrenaline containing local anesthesia during tooth extraction on patient’s blood pressure, blood glucose levels and pulse rate in comparison to plain local anesthetic agents without adrenaline. These physiological changes, although transient, were notably higher in the adrenaline group, highlighting the sympathomimetic effects of adrenaline. Adrenaline a vasoconstrictor can stimulate a stress response in patients with a tendency to increase the blood glucose levels and can also significant effect the cardiovascular parameter like blood pressure and heart rate. Therefore, when adrenaline is used clinically, extra precautions have to be implemented for normal individual as well as diabetic and hypertensive patients. Therefore, bit is best suggested that after complete evaluation of the patient health condition a decision should be made to administer either plain local anesthetic without adrenaline or a adrenaline containing anesthetic agent instead of indiscriminately using the local anesthesia with adrenaline fro all the extraction cases.

The study emphasis that it is important to use selective Individualize care plans to support individuals with diabetes and cardiovascular issues like hypertension and increased pulse rate.

Added value of the study or strength of the study

The study advocates the necessity of innovative intervention therapy for patients undergoing tooth extraction keeping in mind the health condition of the patient.

Future aspect

The future studies should focus on developing newer local anesthetic protocol particularity for healthy individuals as well as diabetic and cardiovascular patients. Novel adrenaline free anesthetic agents with potent vasoconstrictor effect or any alternate drug delivery method should be considered as a safer option for the patients.. The future studies should be conducted for long-term period with a larger sample size assessing the impact of these anesthetics. agents. Further exploration is needed to optimize pain management during tooth extraction keeping in mind patient-specific factors, such as surgical stress, and physiological health factors.

CONCLUSION

The present study demonstrates that the use of adrenaline-containing local anesthesia during tooth extractions should have a cautious approach when dealing with patients. While the technique is effective for achieving hemostasis and prolonged anesthetic action, caution is advised, particularly in elderly or medically compromised patients. Careful patient selection and continuous monitoring are essential to minimize potential complications.

Authors Contribution

SP contributed to the concept of the study review and methodology, PLV contributed to the concept of the study, review and methodology, UK contributed to the collection of the data, statistic and results, SNV contributed to concept and discussion, PK contributed to discussion, UV contributed to review and NKR contributed to review, results and discussion.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.