Buffered Anesthetic Solution in the Treatment of Mandibular Primary Molars

Evaluation of the Effect of Buffered Anesthetic Solution (Lidocaine 2%) in the Effectiveness of Inferior Alveolar Nerve Block Injection During the Treatment of Mandibular Primary Molars

In a prospective, randomized clinical trial, triple-blind, split-mouth study, 40 children aged between 7 to 10 with bilateral mandibular primary molars were diagnosed with pulpitis. The test agent was 2% lidocaine with 1:80.000 epinephrine buffered with sodium bicarbonate 8.4% at a ratio of 1/10, as opposed to the control agent, which was non- buffered 2% lidocaine with 1:80,000 epinephrine. The pain will be assessed during inferior alveolar nerve block injection (IANB) and the effectiveness of anesthesia using the subjective Wong-Baker visual analog scale, the objective sound, eye, and motor (SEM) scale, and the physiological pain scale (pulse rate) using a pulse oximeter. The investigator has confirmed the onset of anesthesia after lip tongue-numbing by probing the gingiva until there is no pain. Endo-ice has been used to assess the onset of pulp anesthesia.

Study Overview

• Status: Completed
• Conditions: Local Anesthesia
• Intervention / Treatment: Combination product: Buffered lidocaine in inferior alveolar nerve block injection; Drug: lidocaine 2% in inferior alveolar nerve block injection

Detailed Description

In a prospective, randomized clinical trial and triple-blind, split mouth study, 40 children aged between 7 to 10 with bilateral mandibular primary molars were diagnosed with pulpitis. Random numbers between 1 to 40 were assigned to patients, with some receiving buffered lidocaine at their initial appointment while others received unbuffered lidocaine. The solutions have been switched up for the second session, which has been set for one week later. The test agent was 2% lidocaine with 1:80.000 epinephrine buffered with sodium bicarbonate 8.4% at a ratio of 1/10, as opposed to the control agent, non-buffering 2% lidocaine with 1:80,000 epinephrine. Buffered lidocaine has been freshly prepared by mixing sodium bicarbonate (8.4%) with the anaesthetic solution (lidocaine 2% with epinephrine 1/80.000) in a 1:10 ratio by volume. Two percent benzocaine gel is applied at the injection site for one minute before inferior alveolar nerve block injection (IANB). The investigator has assessed pain during IANB injection using the subjective Wong-Baker visual analogue scale, the objective sound, eye, and motor (SEM) scale, and the physiological pain scale (pulse rate) using a pulse oximeter. After administering the IANB injection, the investigator has confirmed the onset of anaesthesia after lip and tongue numbing by probing the gingiva every 30 seconds until there is no pain. Endo-ice has been used to assess the onset of pulp anaesthesia every 30 seconds. The effectiveness of anaesthesia has been assessed during the preparation of the pulp chamber using subjective, objective, and physiological pain scales. Finally, the numerical data will be statistically analysed, and any statistically significant values will be investigated.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Phase 4

Contacts and Locations

Study Locations

• Syrian Arab Republic
  • Al-Mazzeh Saint
    • Damascus, Al-Mazzeh Saint, Syrian Arab Republic, Damascus P.O.Box 3062
      • College of dentistry.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 10 years (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Children who are healthy and free of any underlying conditions that might make local anesthesia impossible to administer.
• Children that are not allergic to (lidocaine, adrenaline, or sodium bicarbonate).
• Children aged 6-10 years old
• Cooperative children on Frankel scale (positive or absolute positive).
• children needing bilateral (right and left) endodontic treatment for the mandibular primary molars.
• A positive outcome on the cold test for the target tooth.

Exclusion Criteria:

• Uncooperative children on Frankel's scale (passive or absolute positive).
• The presence of a fistula.
• The presence of an abscess associated with the target tooth.
• The presence of a periapical lesion radially.
• Negative response to the cold test.
• Children suffering from systemic conditions.
• Children who are allergic to (lidocaine, adrenaline, sodium bicarbonate).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Buffered lidocaine; Inferior alveolar nerve block with buffered anesthetic solution (2% lidocaine with 1/80000 adrenaline mixed with sodium bicarbonate 8.4%)	Combination product: Buffered lidocaine in inferior alveolar nerve block injection; Buffered Lidocaine 2% with epinephrine 1.80000 mixed with 1.8% sodium bicarbonate in IANB injection in the treatment of bilateral primary mandibular molars; Other Names: Buffered lidocaine
Other: Lidocaine 2%; Control group: Inferior alveolar nerve block with anesthetic solution (Lidocaine 2% with adrenaline 1.80000).	Drug: lidocaine 2% in inferior alveolar nerve block injection; Lidocaine 2% with epinephrine 1.80000 in IANB injection in the treatment of bilateral primary mandibular molars

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Probing the gingiva	The onset of anaesthesia at soft tissue will be assessed by probing the gingiva After IANB injection.	directly after asking the child about lip, tongue numbing every 30 seconds until there is no pain.
Endo - ice test	The investigator will use endo-ice to assess the onset time of pulp anaesthesia.	Every 30 seconds after confirmed soft tissues anaesthesia until the absence of pain.
Pulse rate	Pulse rate is a physiological pain scale which will be taken through a finger pulse oximeter.	A minute before anaesthesia.
Pulse rate	Pulse rate is a physiological pain scale, will be taken through a finger pulse oximeter.	20 seconds after the first quarter of the local anaesthesia.
Wong baker faces scale.	Wong Baker faces scale is a subjective pain which contains a series of six faces ranging from a happy face at 0 to indicate "no hurt" to a crying face at 10 to indicate "hurts worst"	One minute after IANB injection
Sound, eye, motor scale (SEM)	Sound, eye, motor scale is an objective pain scale for the assessment of child's behaviour by recording video during anaesthesia	Within five seconds from the start of the local anesthetic injection to completion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pulse rate	Pulse rate is a physiological pain scale which will be taken through a finger pulse oximeter.	20 seconds after opening the pulp chamber
sound, eye, motor scale (SEM)	Sound, eye, motor scale is an objective pain scale for the assessment of child's behaviour by recording video during endo access preparation	Within five seconds from the start of the local anaesthetic injection to completion
Wong baker faces scale	Wong Baker faces scale is a subjective pain which contains a series of six faces ranging from a happy face at 0 to indicate "no hurt" to a crying face at 10 to indicate "hurts worst"	one minute after preparing pulp chamber

Collaborators and Investigators

• Sponsor: Damascus University
• Investigators: Study Director: Hanadi Almattit, Phd,lecturer, Co- supervisal; Study Director: Chaza Kouchaji, Professor, Supervisal

Publications and helpful links

General Publications

• Chopra R, Jindal G, Sachdev V, Sandhu M. Double-Blind Crossover Study to Compare Pain Experience During Inferior Alveolar Nerve Block Administration Using Buffered Two Percent Lidocaine in Children. Pediatr Dent. 2016 Jan-Feb;38(1):25-9.
• Goodchild JH, Donaldson M. Novel Direct Injection Chairside Buffering Technique for Local Anesthetic Use in Dentistry. Compend Contin Educ Dent. 2019 Jul/Aug;40(7):e1-e10.
• Meincken M, Norman C, Arevalo O, Saman DM, Bejarano T. Anesthesia Onset Time and Injection Pain Between Buffered and Unbuffered Lidocaine Used as Local Anesthetic for Dental Care in Children. Pediatr Dent. 2019 Sep 15;41(5):354-357.
• Kurien RS, Goswami M, Singh S. 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. J Dent Res Dent Clin Dent Prospects. 2018 Spring;12(2):102-109. doi: 10.15171/joddd.2018.016. Epub 2018 Jun 20.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2022
• Primary Completion (Actual): March 1, 2023
• Study Completion (Actual): April 3, 2023

Study Registration Dates

• First Submitted: February 7, 2023
• First Submitted That Met QC Criteria: March 20, 2023
• First Posted (Actual): March 31, 2023

Study Record Updates

• Last Update Posted (Actual): September 29, 2023
• Last Update Submitted That Met QC Criteria: September 27, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: Buffered lidocaine
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Arrhythmia Agents; Central Nervous System Depressants; Peripheral Nervous System Agents; Sensory System Agents; Anesthetics; Membrane Transport Modulators; Anesthetics, Local; Voltage-Gated Sodium Channel Blockers; Sodium Channel Blockers; Lidocaine
• Other Study ID Numbers: UDDS-Pedo-03-2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No