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Background: Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO 4), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO 4 in patients with symptomatic irreversible pulpitis and apical periodontitis. Methods: Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO 4 (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker-Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. Results: Administration of 150 mg MgSO 4 hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. Conclusion: Combining 75 mg or 150 mg of MgSO 4 with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO 4 is adequate for endodontic procedures.

Objective: Local anaesthetic solution that is commonly employed for supplemental intrapulpal injection (IPI) may routinely come in contact with subsequently used sodium hypochlorite (NaOCl) during endodontic treatment of symptomatic irreversible pulpitis cases. This in vitro study investigated the available free active chlorine (FAC) content of 3% NaOCl after mixing with 2% lignocaine hydrochloride with adrenaline (LA) solution in three different proportions using iodometric titration analysis. Methods: Aliquots of 3% NaOCl (control) in different measures (30 mL, 27 mL, 21 mL and 15 mL) served as the effective concentrate of various proportions of NaOCl admixed with the test solutions, i.e., demineralised water (DM) and LA. The mixed aliquots containing NaOCl-DM and NaOCl-LA combination solutions admixed in various proportions (9:1, 7:3 and 1:1 w/v) respectively served as the experimental groups. Iodometric titration was performed to determine the FAC of each independent solution.The results were then evaluated using one-way ANOVA and Tukey’s post hoc analysis to determine the differences between various groups and amongst the individual admixtures. The level of significance was set at P<0.05. Results: Inter-group comparisons revealed statistically significant differences (P<0.05) between all the test groups. An intra-group analysis revealed significant differences (P<0.05) in group 2, whereas no differences (P>0.05) were observed in group 3. Further, there was a dose dependent reduction in FAC content in both the experimental groups with lowest FAC values were observed in 1:1 solution admixtures followed by 7:3 and 9:1 proportions. Conclusion: There was a significant reduction in NaOCl FAC content when admixed with lignocaine HCl even in small proportions. Hence, adequate measures should be taken to remove the residual LA from the pulpal space, before the use of NaOCl after IPI administration.

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