Small study found that pre-operative ibuprofen improved efficacy of inferior alveolar nerve blocks


Inferior alveolar nerve block (IANB) is a routine technique for achieving regional anaesthesia. However, it is not always successful, with inflammation being a potential cause.  The aim of this study was to evaluate the effect of preoperative oral ibuprofen (IBU) on the success of inferior alveolar nerve blocks (IANBs) with mepivacaine containing 1: 100 000 epinephrine for patients with symptomatic irreversible pulpitis (SIP)

Adult patients (≥ 18 yrs), with SIP in posterior mandibular region and having not used medication in previous 24hrs or have any medical contradictions were randomised.  The intervention group received 600-mg ibuprofen (IBU) 1 hour before the administration of IANB with 2% mepivacaine containing 1:100 000 epinephrine.  The control group received placebo followed by IANB. Pain was scored using a Heft-Parker visual analogue scale (VAS) based on a 170-mm line determining the pain level. Evaluations were conducted by an independent observer.

  • 25 patients were allocated to each group
  • Statistically significant differences were observed between the IBU  and Placebo groups (P < 0.05);
  • Success rates for the IANB were 72% (IBU) and 36% (Placebo).
  • At 24 h, only four patients had moderate-to-severe pain (1 of IBU and 3 of Placebo).
  • At 48 h, no patients reported pain.
  • No patient reported adverse effects.

The authors concluded

Preoperative oral administration of IBU significantly improved the efficacy of mepivacaine IANB in patients with symptomatic irreversible pulpitis.


In Dental Elf 5th June 2012 we looked at a study using pre-operative ibuprofen prior to third molar removal. That study did not look at anesthetic efficacy only post operative pain, swelling and trismus but did not find any difference between the groups.


Noguera-Gonzalez D, Cerda-Cristerna BI, Chavarria-Bolaños D, Flores-Reyes H, Pozos-Guillen A. Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J. 2013 Mar 11. doi: 10.1111/iej.12099. [Epub ahead of print] PubMed PMID: 23561002.

Dental Elf 5th June 2012 – Taking ibuprofen before wisdom tooth removal does not appear to be more effective for controlling post operative pain



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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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