Effectiveness of Premedication with Analgesics vs Placebo for Success of Inferior Alveolar Nerve Block in Irreversible Pulpitis

ABSTRACT Pain is considered to be the major cause for seeking emergency endodontic treatment. Pain management is of vital importance in endodontics with no exception. Local anesthesia is considered to be the primary method to control pain. An effective local anesthesia cannot be obtained if pulp is inflamed. Clinician prescribes nonsteroidal anti-inflammatory drugs (NSAIDs) as premedication on a routine basis for mild to moderate pain to reduce pulpal inflammation before injecting anesthesia. These drugs are beneficial in providing relief from pain and inflammation in irreversible pulpitis and helps in providing effectiveness of inferior alveolar nerve block. Moreover, they have a short half life, which would make them ideal for a single dosage prior to the management of severe pain. Aim To conduct a randomized-placebo controlled clinical trial to compare the effectiveness of premedication with analgesics vs placebo for success of inferior alveolar nerve block in irreversible pulpitis. Materials and methods The study consisted of 80 adult patients attending operative Outpatient Department in Baqai Dental College. Informed Consent was obtained from each participant. Subjects were randomly divided in four groups comprising of 20 subjects in each group. Group A received piroxicam (Feldene 20 mg, Pfizer), group B received diclofenac potassium (Fastaid Plus, 50 mg platinum pharmaceutic), group C received naproxen sodium (Synflex 550 mg, ICI), and group D received a placebo drug becefol (Abbott). Medication was given 1 hour before initiating endodontic treatment. After 1 hour of oral administration of tablets, inferior alveolar nerve block using 1.8 ml of 2% lidocaine containing 1: 200,000 epinephrine was given. After 15 minutes, access cavity preparation was initiated and patients were asked to inform if they experienced pain. Patients were excluded from the study if they experienced pain but if the patient did not feel pain endodontic treatment was continued. p-value was set at 0.05. Data was analyzed by using Chi-square test (SPSS 19). Results The result showed that out of 80 patients who participated in the study, success rate for piroxicam came out to 90% (10 male and 8 female patients), followed by diclofenac potassium with 75% success rate (9 male and 6 female patients), naproxen sodium with 35% success rate (3 male and 4 female patients) and placebo with 10% success (1 male and 1 female patient). Conclusion The current study concludes that premedication given 1 hour before injecting anesthesia is helpful in reducing pain intensity and thus causing inferior alveolar nerve block to be effective. How to cite this article Wali A, Siddiqui TM, Qamar N, Khan R, Jawaid N. Effectiveness of Premedication with Analgesics vs Placebo for Success of Inferior Alveolar Nerve Block in Irreversible Pulpitis. Int J Prosthodont Restor Dent 2012;2(1):5-9.