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

• Published in: Journal of endodontics Vol. 41; no. 6; pp. 791 - 796
• Main Authors: Schellenberg, Jared, DDS, MS, Drum, Melissa, DDS, MS, Reader, Al, DDS, MS, Nusstein, John, DDS, MS, Fowler, Sara, DMD, MS, Beck, Mike, DDS, MA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Adolescent; Adult; Alveolar Process - innervation; Anesthetics, Local - administration & dosage; Buffered lidocaine; Dentistry; Double-Blind Method; Endocrinology & Metabolism; Female; Humans; inferior alveolar nerve block; irreversible pulpitis; lidocaine; Lidocaine - administration & dosage; Male; Middle Aged; Nerve Block - methods; Prospective Studies; Pulpitis - therapy; symptomatic irreversible pulpitis; Young Adult; Buffered lidocaine; irreversible pulpitis; symptomatic irreversible pulpitis; inferior alveolar nerve block; lidocaine
• ISSN: 0099-2399; 1878-3554
• DOI: 10.1016/j.joen.2015.02.022

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.