Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial

Abstract

Background The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp. Methods One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment. Results The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups. Conclusion Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

Effect of Prophylactically Administered Ketorolac and Diclofenac Potassium on the Efficacy of Inferior Alveolar Nerve Block in Patients With Symptomatic Irreversible Pulpitis, Double-Blind Randomized Control Trial

“…15 Ketorolac has shown promising results in most studies, however Kumar et al reported statistically insignificant difference in pain improvement threshold between prophylactic ketorolac and paracetamol on the success of IANB. 32 A systematic review by Sivaramakrishnan et al included four studies to evaluate the success of IANB in conjunction with ketorolac as compared to other NSAIDs and placebo. The authors concluded that oral premedication with ketorolac should be considered before initiation of endodontic treatment.…”

“…15 Ketorolac has shown promising results in most studies, however Kumar et al reported statistically insignificant difference in pain improvement threshold between prophylactic ketorolac and paracetamol on the success of IANB. 32…”

Addendum: Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial

“…The above mentioned article [ 1 ] was published in the Journal of Dental Anesthesia and Pain Medicine with the clinical trial registration number missing. The correct clinical trial registration number in Notes is written bellow:…”