Effect of Buffered 4% Lidocaine on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study.

Abstract

INTRODUCTION:

Medical studies have suggested that buffering local anesthetic may increase the ability to achieve anesthesia. The purpose of this study was to determine the effect of 4% buffered lidocaine on the anesthetic success of the inferior alveolar nerve (IAN) block in patients experiencing symptomatic irreversible pulpitis.

METHODS:

One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received a conventional IAN block using either 2.8 mL 4% lidocaine with 1:100,000 epinephrine or 2.8 mL 4% lidocaine with 1:100,000 epinephrine buffered with sodium bicarbonate in a double-blind manner. For the buffered solution, each cartridge was buffered with 8.4% sodium bicarbonate using the OnPharma (Los Gatos, CA) system to produce a final concentration of 0.18 mEq/mL sodium bicarbonate. Fifteen minutes after administration of the IAN block, profound lip numbness was confirmed, and endodontic access was initiated. Success was defined as no or mild pain (≤54 mm on a 170-mm visual analog scale) on access or instrumentation of the root canal.

RESULTS:

The success rate for the IAN block was 32% for the buffered group and 40% for the nonbuffered group, with no significant difference (P = .4047) between the groups. Injection pain ratings for the IAN block were not significantly (P = .9080) different between the 2 formulations.

CONCLUSIONS:

For mandibular posterior teeth, a 4% buffered lidocaine formulation did not result in a statistically significant increase in the success rate or a decrease in injection pain of the IAN block in patients with symptomatic irreversible pulpitis.

• Authors: Jared Schellenberg, Melissa Drum, Al Reader, John Nusstein, Sara Fowler, Mike Beck
• Journal: Journal of endodontics (J Endod) Vol. 41 Issue 6 Pg. 791-6 (Jun 2015) ISSN: 1878-3554 [Electronic] United States
• PMID: 25841959 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015. Published by Elsevier Inc.

Chemical References

• Anesthetics, Local
• Lidocaine

Topics

• Adolescent
• Adult
• Alveolar Process (innervation)
• Anesthetics, Local (administration & dosage)
• Double-Blind Method
• Female
• Humans
• Lidocaine (administration & dosage)
• Male
• Middle Aged
• Nerve Block (methods)
• Prospective Studies
• Pulpitis (therapy)
• Young Adult