Preoperative NSAIDs improve local anaesthetic success for root canal treatment of mandibular teeth

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Inferior alveolar nerve block (IANB) is the most frequently used injection technique for achieving local anaesthesia for root canal treatment of mandibular teeth. However it is not always successful in endodontics with studies failure rates occurring between 44% and 81% of the time.  The aim of this randomised trial was to determine the effect of administration of preoperative lornoxicam (LNX) or diclofenac potassium (DP) on the success of inferior alveolar nerve blocks (IANB) in patients with irreversible pulpitis.

114 patients with irreversible pulpitis of a mandibular posterior were randomly divided into three groups (n = 38). They received identical capsules of either 8 mg LNX, 50 mg DP or placebo (PLAC), one hour before administration of an IANB with 2% lidocaine containing 1:200,000 epinephrine. Anaesthesia was assessed after 15 minutes and access cavities prepared.  The data were analysed using chi-squared tests.

They found  a significant (P < 0.001) difference in the success rates between the LNX and the PLAC groups only (see table).

[table id=4 /]

They concluded:

Pre-operative administration of LNX significantly improved the efficacy of IANB in patients with irreversible pulpitis, whilst the effect of premedication with DP was not significantly different from the PLAC.

Prasanna N, Subbarao CV, Gutmann JL. The efficacy of pre-operative oral medication of lornoxicam and diclofenac potassium on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a double-blind, randomised controlled clinical trial. Int Endod J. 2011 Apr;44(4):330-6. PubMed PMID: 21692235

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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