Title Buffered Lidocaine Does Not Improve the Inferior Alveolar Block Success For Mandibular Posterior Teeth With Symptomatic Irreversible Pulpitis
Clinical Question For patients with symptomatic irreversible pulpitis, is Lidocaine buffered with Sodium Bicarbonate a more successful anesthetic compared to conventional non-buffered Lidocaine when administered as an inferior alveolar nerve block?
Clinical Bottom Line Buffered Lidocaine for inferior alveolar nerve (IAN) block does not result in statistically significant increased success rate of IAN block or decrease in injection pain on mandibular posterior teeth with symptomatic irreversible pulpitis.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25841959Schellenberg/2015100 patients with symptomatic irreversible pulpitis of mandibular posterior teethRandomized Controlled Trial
Key resultsThe success rates of IAN block for buffered and non-buffered 4% Lidocaine were similar. Success rate with buffered Lidocaine was 32% as against 40% with non-buffered Lidocaine (P = .40). Articaine was used among patients with anesthetic failure with similar success rates, 38% and 37% (P = .89) in buffered and non-buffered Lidocaine group respectively. Overall discomfort rating between the two groups during different phases of injection was also similar.
25442722Saatchi/201580 patients with symptomatic irreversible pulpitis of mandibular posterior teethRandomized Controlled Trial
Key resultsAlthough success rate of buffered 2% Lidocaine was higher than with non-buffered 2% Lidocaine (62.5% vs 47.5%), the difference was not statistically significant (P = .381).
Evidence Search ("buffers"[Pharmacological Action] OR "buffers"[MeSH Terms] OR "buffers"[All Fields] OR "buffered"[All Fields]) AND ("lidocaine"[MeSH Terms] OR "lidocaine"[All Fields]) AND ("nerve block"[MeSH Terms] OR ("nerve"[All Fields] AND "block"[All Fields]) OR "nerve block"[All Fields]) AND ("pulpitis"[MeSH Terms] OR "pulpitis"[All Fields])
Comments on
The Evidence
Validity: Both the studies with a moderate sample size (80-100) and the study design being prospective, randomized, double blind clinical trial provided high level of evidence. The study groups in the two studies were well matched for different variables (age, sex, tooth type). Different concentrations of Lidocaine were used in the two studies. Lidocaine 2% was used by Saatchi et. al., whereas a higher concentration of 4% was used in the study by Schellenberg et.al., with the aim to provide more anesthetic molecules. However, despite different success rates for IAN blocks in these studies, they both found no statistically significant differences between buffered and non-buffered lidocaine injections. Perspective: Buffering Lidocaine with Sodium Bicarbonate for alkalinizing the extracellular pH was intended to improve the IAN block efficacy, but the available evidence does not show any statistically significant difference.
Applicability Buffered Lidocaine is not superior to conventional non-buffered Lidocaine in providing successful anesthesia when administered as an inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. In addition, buffered lidocaine is more expensive, less readily available and due to the short half-life requires a chair side preparation, making it a less preferable anesthetic solution. Increasing the Lidocaine concentration with buffered solutions does not change the anesthesia outcome that is often poor for cases of mandibular molars diagnosed with irreversible pulpitis. Regardless, supplemental injections, in particular via an intra-osseous route, are needed to achieve adequate anesthesia.
Specialty (Endodontics) (General Dentistry) (Oral Surgery) (Pediatric Dentistry)
Keywords Buffered Lidocaine; Inferior alveolar nerve block; Lidocaine; Symptomatic irreversible pulpitis, lido(caine),
ID# 2946
Date of submission 10/16/2015
E-mail joon@livemail.uthscsa.edu
Author Ruchika Joon, DDS
Co-author(s) e-mail
Faculty mentor Anibal Diogenes, DDS, MS, PhD
Faculty mentor e-mail diogenes@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available