Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: A randomized controlled clinical trial

Abstract

Background: Maintaining primary teeth in the oral cavity is of prime importance, and grossly carious teeth may require pulp therapy for the same. Pain on injection and incomplete anesthesia causes failure of the procedure and result in fear and anxiety. Various methods have evolved to overcome this; such as distraction, topical anesthesia, etc. A few techniques regaining popularity in dentistry in recent times is the warming or buffering of the solution prior to administration. This study thus aimed to compare and evaluate the anesthetic efficacy and the patient’s pain reaction to pre-warmed, buffered and conventional 2% lignocaine for the success of Inferior Alveolar Nerve Block in mandibular primary molars undergoing pulp therapy. Methods: The study is a randomized, split-mouth trial. Sixty children between six -12 years, requiring pulp therapy bilaterally on mandibular primary molars, were administered conventional, buffered or pre-warmed 2% lignocaine on two separate appointments. Various parameters were assessed using objective and subjective scales. Results: Pre-warmed and buffered anesthetics had lesser pain on injection (p<0.001, p<0.001) and pulp therapy (p=0.001, p=0.014), faster onset of action (p=0.004, p=0.001), lower SEM Sound (p=0.035, p=0.028), Eye (p< 0.001, p=0.013) and Motor (p=0.008, p=0.021) scores and shorter duration of action (p< 0.001, p=0.015). No significant difference was found between the two modified solutions. Thus pre-warmed and buffered anesthetic solutions fared better than the conventional solution for all parameters but had no advantage over each other. Conclusion: Buffering or pre-warming the anesthetic solution reduces pain on administration and during procedures in children. Trial registration number: CTRI/2017/02/007922

Effect of warming local anesthesia solutions before intraoral administration in dentistry: a systematic review

“…Warming the local anesthetic solution is accomplished with the thermostatic heat bath [10,13], baby bottle warmer [11],…”

“…Both infiltrations and blocks were evaluated in the study by Ram et al, 2002 [13]. [11,13], and the other two studies used Wong Baker-FACES Pain Scale (WB-FPS) [9,10]. Only the study by Ram et al, 2002, reported Conclusions: Based on the aforementioned discussion, the following conclusions can be drawn:…”

“…(which used articaine 4%) [9], the remaining three studies reported the usage of lignocaine [10,11,13]. A high concentration of epinephrine (1:1,00,000) was used in two studies [11,13].…”

Randomized Clinical Trial of Anesthetic Efficacy of Buffered Versus Conventional Local Anesthetic Agent in Patient with Symptomatic Irreversible Pulpitis

“…This is the first study to be reported in the literature where conventional and buffered lignocaine as well as articaine have been used as the study groups. Previous study by Kurien et al used warm,buffered and conventional lignocaine as the study groups [27]. Buffered articaine is statistically significantly a better anesthetic agent when compared to conventional or buffered lignocaine (Tables 1, 2 and 3).…”

Avaliação da eficácia anestésica da Mepivacaína na exodontia de molares inferiores com lesão apical

“…Esta propriedade está diretamente ligada com a duração da ação do anestésico e é representada pela porcentagem de fármaco circulante ligada a proteínas e pode correlacionar-se com a afinidade de um anestésico por proteínas dentro dos canais de sódio. Quanto maior a tendência de ligação às proteínas, mais tempo o anestésico sustentará o bloqueio neural (Brunton et al, 2005;Catteral, Mackie, 2006;Malamed, 2013) A lidocaina é o anestésico padrão de comparação nos trabalhos, onde se estuda a eficácia anestésica, tempo de latência e duração de anestésicos (Tortamano et al, 2009, Elbay et al, 2016Visconti et al,2016, Cook et al,2018, Kurien et al, 2018, Ranjan et al, 2018,,Badr , Aps, 2018. É o mais usual anestésico local de uso odontológico, e está sempre associado a um vasoconstritor, geralmente a epinefrina, com concentração usual de 1:100 000 ou 1:200.000 (Tabela.1) (Malamed, 2013).…”