Efficacy of mepivacaine–tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial

Rodríguez-Wong, Laura; Pozos‐Guillén, Amaury; Silva-Herzog, Daniel; Chavarría‐Bolaños, Daniel

doi:10.1111/iej.12463

Cited by 24 publications

(43 citation statements)

References 53 publications

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“…Several clinical and pharmacological strategies such as supplementary techniques or analgesic premedication are recommended to prevent painful treatments and patient discomfort. Thorough anesthesia throughout the entire endodontic treatment promotes a more comfortable postoperative recovery and can decrease analgesic drug consumption [8, 31, 32]. …”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported a 30–80% failure rate for IANBs in patients with symptomatic irreversible pulpitis (SIP) [5–8]. Several theories have been proposed to explain local anesthetic failure; these theories include ionized anesthetic solutions in the inflamed tissue with a lower local pH, the overexpression and hyperactivity of voltage-gated sodium channels due to the presence of prostaglandins, and the overexpression of tetrodotoxin-resistant sodium channels [2, 5, 6, 8]. …”

Section: Introductionmentioning

confidence: 99%

“…Some factors, such as lip numbness, a lack of response to cold stimuli, an electric pulp test, and an absence of pain during endodontic access, have been proposed to assess successful IANBs [6, 12, 13]. Several studies have reported that a negative response in the cold test or lip numbness does not guarantee pulp anesthesia [6, 8, 12–15]. Clinicians have been recommended to apply three diagnostic tests (lip numbness, lack of response to cold stimuli and absence of pain during endodontic access) to evaluate an IANB as a successful anesthetic technique [8].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported that a negative response in the cold test or lip numbness does not guarantee pulp anesthesia [6, 8, 12–15]. Clinicians have been recommended to apply three diagnostic tests (lip numbness, lack of response to cold stimuli and absence of pain during endodontic access) to evaluate an IANB as a successful anesthetic technique [8]. …”

Section: Introductionmentioning

confidence: 99%

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Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

Chavarría‐Bolaños

Rodríguez-Wong

Noguera-González

et al. 2017

Pain Research and Management

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Introduction The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). Methodology A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. Results IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). Conclusion None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

Chavarría‐Bolaños

Rodríguez-Wong

Noguera-González

et al. 2017

Pain Research and Management

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“…In this second research, the blockade with Articaine plus Tramadol showed also an increased duration. A recent investigation tried to evaluate a new combination between Mepivacaine and Tramadol, but in this case when the inferior alveolar nerve blockade was done in patients that suffer acute pain due to symptomatic irreversible pulpitis (27). This study showed that even when the combination didn´t increase the success rate of the blockade, it did increase the duration of the anesthetic effect.…”

mentioning

confidence: 99%

Peripheral Tramadol in Dentistry: A New Use for an Old Drug

Chavarría

Pozos

2016

Odovtos - Int J Dent Sc

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Tramadol is a well known central acting analgesic drug, used in a wide variety of treatments within health sciences; including dentistry. Due to its lack of anti-inflammatory action and some adverse effects related mainly to opioid receptors agonism, it is not use as a routine alternative; keeping mainly for patients allergic to non-steroideal anti-inflammatory drugs or as an adjuvant to manage severe odontogenic pain. Since new available evidence supports the possible analgesic effect of this drug when is applied locally in different sites, recent reports have been done to explore the same effect in the orofacial region, especially to improve the local management of odontogenic pain. This new perspective article summarize some of the current efforts develop to explore the peripheral Tramadol in dentistry; "a new use for an old drug". KEYWORDSOld drugs; Peripheral tramadol; Local analgesics. RESUMENEl Tramadol es un fármaco de acción central bien conocido, usado en una gran variedad de tratamientos dentro de las ciencias de la salud; y la odontología no es la excepción. Debido a su falta de acción antiinflamatoria y a varios efectos adversos asociados principalmente al agonismo de receptores opioides, este no es usado como una alternativa de rutina; y se mantiene principalmente para pacientes alérgicos a antiinflamatorios no esteroideos o como coadyuvante en el manejo de dolor odontogénico severo. Sin embargo, ya que nueva evidencia disponible apoya su posible efecto analgésico al aplicarse localmente en diferentes sitios, investigaciones recientes se han realizado tratando de explorar el mismo efecto en la región orofacial, especialmente para mejorar el manejo local del dolor odontogénico. Este artículo de "nueva perspectiva" resume algunos de los esfuerzos recientes desarrollados para explorar el Tramadol periférico en odontología; un nuevo uso para un viejo medicamente.

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Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia

et al. 2018

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Efficacy of mepivacaine–tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial

Cited by 24 publications

References 53 publications

Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

Peripheral Tramadol in Dentistry: A New Use for an Old Drug

Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia

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