Clonidine Safer than Epinephrine for Intraoral Anesthesia in Diabetic Patients, suggests study

A recent clinical trial published in The Journal of Evidence-Based Dental Practice revealed the efficacy, cardiovascular safety, and side effects of different anesthetic solutions for maxillary infiltration anesthesia in patients with and without type 2 diabetes mellitus (DMT2). The study compared the use of 2% lidocaine with clonidine (15 mcg/ml) and 2% lidocaine with epinephrine (1:100,000), which found significant differences in onset, duration, anesthetic spread, and postoperative effects.

The study included 63 patients with type 2 diabetes mellitus (DMT2) and 52 non-diabetic participants which showed clear differences in anesthetic response based on diabetes status. One of the key findings of this study was the shorter onset time for anesthesia in diabetic patients when compared to their non-diabetic counterparts, regardless of the anesthetic solution used.

Diabetic patients experienced a 59% longer anesthesia duration with lidocaine and epinephrine (LE) and a 28% longer duration with lidocaine and clonidine (LC) compared to non-diabetics. Anesthesia with LE lasted 37.9% longer than with LC (182 minutes versus 139 minutes) when compared the two solutions within diabetic patients. Also, the width of the anesthetic field was markedly wider in diabetics, with LE providing a broader coverage (35.19 mm) compared to LC (27.07 mm).

Blood pressure and heart rate measurements further highlighted the differences between the solutions. Diabetic and non-diabetic patients who were receiving lidocaine with clonidine showed a significant drop in systolic blood pressure (SBP) from the 15th to the 30th minute after administration. Also, lidocaine with epinephrine led to an increase in heart rate in both diabetic and non-diabetic groups during the same timeframe.

Another important discovery was the increased prevalence of postoperative paresthesia in diabetic patients treated with LE when compared to LC. No such cases were observed in non-diabetic patients. Clonidine was found to be a safer alternative to epinephrine in reducing the cardiovascular risks and local side effects without compromising anesthetic effectiveness.

Overall, these findings emphasize the importance of tailoring anesthetic strategies for diabetic patients who were undergoing dental procedures. The favorable safety profile and effective anesthetic properties of clonidine make it a promising option for diabetic patients who may otherwise face increased risks with epinephrine-based solutions.

Source:

Milic, M. S., Brkovic, B., Vucetic, M., Todorovic, V., & Stojic, D. (2025). Efficacy and safety of lidocaine with clonidine for maxillary infiltration anesthesia in patients with diabetes mellitus type 2: double-blind, randomized clinical trial. The Journal of Evidence-Based Dental Practice, 102097. https://doi.org/10.1016/j.jebdp.2025.102097