Effect of fentanyl on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a randomized clinical trial

Efficacy of Lidocaine combined with fentanyl for IANB


Published: 13 April 2022
Abstract Views: 834
PDF: 201
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Neda Shekarchizade Department of Endodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of.
  • Amir Shafa Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of.
  • Mohammad Javad Tarrahi Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of.
  • Niloufar Nafari Department of Oral and Maxillofacial Radiology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of.
  • Marzia Maglitto Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II", Naples, Italy.
  • Alessandra Valletta Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II", Naples, Italy.

Aim: The purpose of this prospective, randomized, double-blind study was to evaluate the effect of adding fentanyl to lidocaine 2% with epinephrine 1:80000 on the success of the inferior alveolar nerve block in mandibular molar teeth with symptomatic irreversible pulpitis.

Methodology:100 healthy adult patients with diagnosis of symptomatic irreversible pulpitis in one of the mandibular molar tooth were selected and randomly divided in two groups of 50 patients each. In the first group (fentanyl group), 0.25 ml of a cartridge of 1.8 ml of 2% lidocaine with 1:80,000 epinephrine solution was drained and the same amount from 50µg/ ml fentanyl solution was added to the cartridge.  In the second group (non-fentanyl group) 0.25 ml of a cartridge of 1.8 ml of 2% lidocaine with 1:80,000 epinephrine solution was drained and the same amount from saline solution was added to the cartridge. Each group received two cartridges of prepared soloution with inferior alveolar nerve block injection technique. Access cavity preparation started 15 minautes after injection and after confirming the lip numbness. Success defined as no pain or mild pain on the basis of Heft-Parker visual analog scale during access cavity preparation or initial instrumentation. Data were analyzed by T-test and Chi-square

Results: The success rate of inferior alveolar nerve block injection was 58% for Fentanyl group and 46% for Non-Fentanyl group. There was no significant difference between the two groups (P = 0.23).

Conclusions: The addition of fentanyl to lidocaine 2% with epinephrine 1:80000 did not increase the success rate of the inferior alveolar nerve block in mandibular molar teeth with symptomatic irreversible pulpitis.


Saatchi M, Farhad AR, Shenasa N, Haghighi SK. Effect of Sodium Bicarbonate Buccal Infiltration on the Success of Inferior Alveolar Nerve Block in Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Double-blind Study. J Endod. 2016;42:1458-61.

Aggarwal V, Jain A, Kabi D. Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis. J Endod. 2009;35:925-9.

Ashraf H, Kazem M, Dianat O, Noghrehkar F. Efficacy of articaine versus lidocaine in block and infiltration anesthesia administered in teeth with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod. 2013;39:6-10.

Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2004;30:568-71.

Matthews R, Drum M, Reader A, Nusstein J, Beck M. Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails. J Endod. 2009;35:343-6.

Rogers BS, Botero TM, McDonald NJ, Gardner RJ, Peters MC. Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod. 2014;40:753-8.

Bokesch PM, Raymond SA, Strichartz GR. Dependence of lidocaine potency on pH and PCO2. Anesth Analg. 1987;66:9-17.

Rood JP, Pateromichelakis S. Inflammation and peripheral nerve sensitisation. Br J Oral Surg. 1981;19:67-72.

Walton RE, Torabinejad M. Managing local anesthesia problems in the endodontic patient. J Am Dent Assoc. 1992;123:97-102.

Wells JE, Bingham V, Rowland KC, Hatton J. Expression of Nav1.9 channels in human dental pulp and trigeminal ganglion. J Endod. 2007;33:1172-6.

Aggarwal V, Singla M, Miglani S, Kohli S, Irfan M. A prospective, randomized single-blind evaluation of effect of injection speed on anesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod. 2012;38:1578-80.

Erramouspe J. BUFFERING LOCAL ANESTHETIC SOLUTIONS WITH SODIUM BICARBONATE : LITERATURE REVIEW AND COMMENTARY. Hospital Pharmacy. 1996;31:1275-82.

Goldberg S, Reader A, Drum M, Nusstein J, Beck M. Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques. J Endod. 2008;34:1306-11.

Hinkley SA, Reader A, Beck M, Meyers WJ. An evaluation of 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with:100,000 epinephrine for inferior alveolar nerve block. Anesth Prog. 1991;38:84-9.

Idris M, Sakkir N, Naik KG, Jayaram NK. Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study. J Conserv Dent. 2014;17:432-5.

Mikesell A, Drum M, Reader A, Beck M. Anesthetic efficacy of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltrations. J Endod. 2008;34:121-5.

Nagendrababu V, Pulikkotil SJ, Veettil SK, Teerawattanapong N, Setzer FC. Effect of Nonsteroidal Anti-inflammatory Drug as an Oral Premedication on the Anesthetic Success of Inferior Alveolar Nerve Block in Treatment of Irreversible Pulpitis: A Systematic Review with Meta-analysis and Trial Sequential Analysis. J Endod. 2018;44:914-22.e2.

Shapiro MR, McDonald NJ, Gardner RJ, Peters MC, Botero TM. Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial. J Endod. 2018;44:523-8.

Walton RE, Abbott BJ. Periodontal ligament injection: a clinical evaluation. J Am Dent Assoc. 1981;103:571-5.

Akhlaghi NM, Hormozi B, Abbott PV, Khalilak Z. Efficacy of Ketorolac Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial. J Endod. 2016;42:691-5.

Bigby J, Reader A, Nusstein J, Beck M. Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2007;33:7-10.

Sakhaeimanesh V, Khazaei S, Kaviani N, Saatchi M, Shafiei M, Khademi A. Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study. Iran Endod J. 2017;12:449-53.

Shadmehr E, Aminozarbian MG, Akhavan A, Mahdavian P, Davoudi A. Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis. Int Endod J. 2017;50:531-9.

https://www.drugs.com/

Ramos-Matos CF, Bistas KG, Lopez-Ojeda W. Fentanyl. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.

Peng PW, Sandler AN. A review of the use of fentanyl analgesia in the management of acute pain in adults. Anesthesiology. 1999;90:576-99.

Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155:2545-50.

Laurence L. Brunton RH-D, Björn C. Knollmann. Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e. new york: McGraw-Hill; 2006. 254-9.

Bujedo BM. Current evidence for spinal opioid selection in postoperative pain. Korean J Pain. 2014;27:200-9.

https://www.dea.gov/

https://www.medicines.org.uk/emc.

Karlsen AP, Pedersen DM, Trautner S, Dahl JB, Hansen MS. Safety of intranasal fentanyl in the out-of-hospital setting: a prospective observational study. Ann Emerg Med. 2014;63:699-703.

Plante GE, VanItallie TB. Opioids for cancer pain: the challenge of optimizing treatment. Metabolism. 2010;59 Suppl 1:S47-52.

Mayes S, Ferrone M. Fentanyl HCl patient-controlled iontophoretic transdermal system for the management of acute postoperative pain. Ann Pharmacother. 2006;40:2178-86.

https://pami.emergency.med.jax.ufl.edu/ [

De Pedro-Muñoz A, Mena-Álvarez J. The effect of preoperative submucosal administration of tramadol on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: a randomized, double-blind placebo-controlled clinical trial. Int Endod J. 2017;50:1134-42.

Aksoy F, Ege B. Efficacy of submucosal tramadol and lidocaine on success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis. Odontology. 2020;108:433-40.

Rodríguez-Wong L, Pozos-Guillen A, Silva-Herzog D, Chavarría-Bolaños D. Efficacy of mepivacaine-tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J. 2016;49:325-33.

Mohammad Javad Tarrahi, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan

Associated Professor of Epidemiology

Shekarchizade, N., Shafa, A., Tarrahi, M. J. ., Nafari, N., Maglitto, M., & Valletta, A. (2022). Effect of fentanyl on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a randomized clinical trial: Efficacy of Lidocaine combined with fentanyl for IANB. Giornale Italiano Di Endodonzia, 36(1). https://doi.org/10.32067/GIE.2021.35.02.56

Downloads

Download data is not yet available.

Citations