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

Reenu Sarah Kurien, Mousumi Goswami, Sanjay Singh, Reenu Sarah Kurien, Mousumi Goswami, Sanjay Singh

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.

Keywords: IANB; Warm; buffered; children; pulp therapy.

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References

    1. 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;38(1):25-9. Retrieved from .
    1. Kudo M. Initial injection pressure for dental local anesthesia: effects on pain and anxiety. Anesth Prog. 2005;52(3):95–101. doi: 10.2344/0003-3006(2005)52[95:iipfdl];2.
    1. Ram D, Hermida LB, Peretz B. A comparison of warmed and room-temperature anesthetic for local anesthesia in children. Pediatr Dent 2002;24(4):333-6. Retrieved from .
    1. Meechan JG, Howlett PC, Smith BD. Factors influencing the discomfort of intraoral needle penetration. Anesth Prog. 2005;52(3):91–4. doi: 10.2344/0003-3006(2005)52[91:FITDOI];2.
    1. Milani AS, Froughreyhani M, Rahimi S, Zand V, Jafarabadi MA. Volume of anesthetic agents and IANB success: A systematic review. Anesth Prog. 2018;65(1):16–23. doi: 10.2344/anpr-65-01-03.
    1. Kalpna Chaudhry, Manisha Shishodia, Chanchal Singh, Avantika tuli. Comparative evaluation of pain perception by vibrating needle (VibrajectTM) and conventional syringe anesthesia during various dental procedures in pediatric patients: A short study . Int Dent Med J Adv Res. 2015;1:1–5. doi: 10.15713/ins.idmjar.5.
    1. Pradhan R, Kulkarni D, Shetty L. Evaluation of efficacy of intraligamentary injection technique for extraction of mandibular teeth- A prospective study. J Clin Diagn Res. 2017;11(1):110–3. doi: 10.7860/JCDR/2017/22204.9302.
    1. Aravena PC, Barrientos C, Troncoso C. Effect of warmed anesthetic solutions on pain during dental injection A randomized clinical trial. J Oral Res. 2015;4(5):306–12. doi: 10.17126/joralres.2015.060.
    1. Fuller JR, Pitts JF, Koornneef L. A simple method of warming local anesthetic solutions. Eye (Lond) 1995;9(pt 6):809–10. doi: 10.1038/eye.1995.204.
    1. Bell RW, Butt ZA, Gardner RF. Warming lignocaine reduces the pain of injection during local anesthetic eyelid surgery. Eye (Lond) 1996;10(pt5):558–60. doi: 10.1038/eye.1996.129.
    1. Bainbridge LC. Comparison of room temperature and body temperature local anesthetic solutions. Br J Plast Surg. 1991;44(2):147–8. doi: 10.1016/0007-1226(91)90050-t.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC. et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomized trials. Int J Surg. 2012;10(1):28–55. doi: 10.1016/j.ijsu.2011.10.001.
    1. Antczak-Bouckoms AA, Tulloch JF, Berkey CS. Split-mouth and cross-over designs in dental research. J Clin Periodontol. 1990;17(7pt1):446–53. doi: 10.1111/j.1600-051x.1990.tb02343.x.
    1. Krishna P. Shetty, Sarvepalli V Satish,Krishnarao Kilaru,Kalyana Chakravarthi Ponangi,Alexander M Luke and Srisha Neshangi An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia. J Dent Res Dent Clin Dent Prospects. 2016 Winter;10(1):31–35. doi: 10.15171/joddd.2016.005.
    1. Malamed S F. Handbook Of Local Anesthesia. 6th ed. St Louis Missouri, Elsevier; 2013.
    1. Allen MJ, Bunce C, Presland AH. The effect of warming local anesthetic on the pain of injection during sub-tenon's anesthesia for cataract surgery. Anaesth. 2008;63(3):276–8. doi: 10.1111/j.1365-2044.2007.05351.x.
    1. Davidson JA, Boom SJ. Warming lignocaine to reduce pain associated with injection. Br Med J. 1992;305(6854):617–8. doi: 10.1097/00132586-199306000-00015.
    1. Aminabadi NA, Vafaei A, Erfanparast L, Oskouei SG, Jamali Z. Impact of pictorial story on pain perception, situational anxiety and behavior in children: a cognitive-behavioral schema. J Clin Pediatr Dent. 2011;36(2):12732. doi: 10.17796/jcpd.36.2.3163251527508338.
    1. Chen E, Craske MG, Katz ER, Schwartz E, Zeltzer LK. Pain-sensitive temperament: does it predict procedural distress and response to psychological treatment among children with cancer? J Pediatr Psychol. 2000;25(4):269–78. doi: 10.1093/jpepsy/25.4.269.
    1. Logothetis DD Anesthetic buffering: new advances for use in dentistry. Regist Dent Hyg 2013;33:61-66. Retrieved from .
    1. Malamed SF, Falkel M. Buffered local anesthetics: the importance of pH and CO2 SAAD Dig 2013;29:9-17. Retrieved from .
    1. Christoph RA, Buchanan L, Begalla K, Schwartz S. Pain reduction in local anesthetic administration through pH buffering. Ann Emerg Med. 1988;17:117–20. doi: 10.1016/s0196-0644(88)80293-2.
    1. McKay W, Morris R, Mushlin P. Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine. Anesth Analg. 1987;66(6):572–574. doi: 10.1213/00000539-198706000-00015.
    1. Gershon RY, Mokriski BK, Matjasko MJ. Intradermal anesthesia and comparison of intravenous catheter gauge. Anesth Analg. 1991;73(4):469–70. doi: 10.1097/00000542-198909001-00433.
    1. Burns CA, Ferris G, Feng C, Cooper JZ, Brown MD. Decreasing the pain of local anesthesia: a prospective, double blind comparison of buffered,premixed 1% lidocaine with epinephrine versus 1% lidocaine freshly mixed with epinephrine. J Am Acad Dermatol. 2006;54(1):128–31. doi: 10.1016/j.jaad.2005.06.043.
    1. Whitcomb M, Drum M, Reader A, Nusstein J, Beck M. A prospective, randomized, double blinded study of anesthetic efficacy of sodium bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Anesth Prog. 2010;57(2):59–66. doi: 10.2344/0003-3006-57.2.59.
    1. DiFazio CA, Carron H, Grosslight KR, Moscicki JC, Bolding WR, Johns RA. Comparison of pH-adjusted lidocaine solutions for epidural anesthesia. Anesth Analg. 1986;65(7):760–4. doi: 10.1097/00132582-198704000-00033.
    1. Sinnott CJ, Garfield JM, Thalhammer JG, Strichartz GR. Addition of sodium bicarbonate to lidocaine decreases the duration of peripheral nerve block in the rat. Anesth. 2000;93:1045–52. doi: 10.1097/00000542-200010000-00028.
    1. Primosch RE, Robinson L. Pain elicited during intraoral infiltration with buffered lignocaine. Am J Dent 1996;9(1):5-10. Retrieved from: .
    1. Powell MF. Stability of lidocaine in aqueous solution: effect of temperature, pH, buffer, and metal ions on amide hydrolysis. Pharm Res 1987;4(1):42-5.Retrieved from .
    1. Alonso PE, Perula LA, Rioja LF. Pain-temperature relation in the application of local anesthesia. Br J Plast Surg. 1993;46(1):76–8. doi: 10.1016/0007-1226(93)90070-r.
    1. Rood JP Rood JP. The temperature of local anesthetic solutions. J Dent. 1977;5(3):213–4. doi: 10.1016/0300-5712(77)90006-9.
    1. Hogan ME, VanderVaart S, Perampaladas K, Machado M, Einarson TR, Taddio A. Systematic review and meta analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;58(1):86–98 e1. doi: 10.1016/j.annemergmed.2010.12.001.
    1. Khatri A, Kalra N. A comparison of two pain scales in the assessment of dental pain in east Delhi children. Int Sch Res Not. 2012:1–4. doi: 10.5402/2012/247351.

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