Effect of Sodium Bicarbonate–buffered Lidocaine on the Success of Inferior Alveolar Nerve Block for Teeth with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Double-blind Study

Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

“…1). Although buffering lidocaine has been shown by Al-Sultan et al (8,9) to improve efficacy for extractions and periapical surgery, Whitcomb et al (7) did not find an increased efficacy with buffered lidocaine for asymptomatic subjects with the IAN block nor did Saatchi et al (11) or Schellenberg et al (12) find a significant difference for IAN blocks in patients presenting with symptomatic irreversible pulpitis. Additionally, Balasco et al (10) did not find decreased pain for an incision and drainage procedure with a buffered lidocaine formulation.…”

“…However, Whitcomb et al (7) did not find an increased efficacy with buffered lidocaine for the inferior alveolar nerve (IAN) block nor did Balasco et al (10) find decreased pain for an incision and drainage procedure with a buffered formulation. Recently, Saatchi et al (11) and Schellenberg et al (12) evaluated buffered 2% lidocaine with 1:80,000 epinephrine formulation and buffered 4% lidocaine with 1:100,000 epinephrine formulation, respectively, for IAN blocks in patients presenting with symptomatic irreversible pulpitis. They both concluded that buffering did not statistically improve anesthetic success.…”

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

“…Therefore, increasing the concentration of lidocaine to 4% does not appear to be any better than using a 2% lidocaine formulation. Recently, Saatchi et al (13) found, using 3.24 mL 2% lidocaine (64.8 mg) with 1:80,000 epinephrine in patients with symptomatic irreversible pulpitis, a success rate (none or mild pain during access or instrumentation) of 47%, which was similar to the results of previous studies using a 2-cartridge volume (28). Unfortunately, we cannot speculate or reach conclusions on differences between the molars and premolars because of the low numbers of premolars in the current study.…”

“…They found no significant difference between the 2 anesthetic formulations regarding pain of injection or pain of the incision and drainage procedure. Recently, Saatchi et al (13) found that using 3.24 mL buffered 2% lidocaine (64.8 mg) with 1:80,000 epinephrine in patients with symptomatic irreversible pulpitis resulted in a success rate (none or mild pain during access or instrumentation) of 62%, which was not statistically different than a nonbuffered formulation. The higher success rate in the study by Saatchi et al (13) may have been caused by population differences.…”

“…They found no significant difference between the 2 formulations regarding pain of injection or pain of the incision and drainage procedure. Recently, Saatchi et al (13) evaluated buffered 2% lidocaine with a 1:80,000 epinephrine formulation for IAN blocks in patients presenting with irreversible pulpitis. They concluded that buffering did not statistically improve the success of the IAN block.…”