A prospective, randomized, double-blind study of the anesthetic efficacy of sodium bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks

Abstract

The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1:100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1:100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1:100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10-71%. For the unbuffered 2% lidocaine with 1:100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10-72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1:100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1:100,000 epinephrine for an IAN block.

Figures

Figure 1

Incidence of second molar anesthesia as determined by lack of response to electric pulp testing at the maximum setting (percentage of 80/80s), at each postinjection time interval, for the 2 anesthetic formulations. No significant differences (P > .05) between the 2 anesthetic formulations were noted.

Figure 2

Incidence of first molar anesthesia as determined by lack of response to electric pulp testing at the maximum setting (percentage of 80/80s), at each postinjection time interval, for the 2 anesthetic formulations. No significant differences (P > .05) between the 2 anesthetic formulations were noted.

Figure 3

Incidence of second premolar anesthesia as determined by lack of response to electric pulp testing at the maximum setting (percentage of 80/80s), at each postinjection time interval, for the 2 anesthetic formulations. No significant differences (P > .05) between the 2 anesthetic formulations were noted.

Figure 4

Incidence of first premolar anesthesia as determined by lack of response to electric pulp testing at the maximum setting (percentage of 80/80s), at each postinjection time interval, for the 2 anesthetic formulations. No significant differences (P > .05) between the 2 anesthetic formulations were noted.

Figure 5

Incidence of lateral incisor anesthesia as determined by lack of response to electric pulp testing at the maximum setting (percentage of 80/80s), at each postinjection time interval, for the 2 anesthetic formulations. No significant differences (P > .05) between the 2 anesthetic formulations were noted.

Figure 6

Incidence of central incisor anesthesia as determined by lack of response to electric pulp testing at the maximum setting (percentage of 80/80s), at each postinjection time interval, for the 2 anesthetic formulations. No significant differences (P > .05) between the 2 anesthetic formulations were noted.