Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double‐blind single‐centre clinical trial

Abstract

Aim The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. Methodology Three hundred and thirty patients with moderate‐to‐severe pain in mandibular molars with SIP randomly received either 3.6 ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4 ml 4% articaine hydrochloride with 1:100 000 adrenalin (n = 165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11‐point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no‐to‐mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann–Whitney U‐ and Chi‐squared (χ2) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre‐disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. Results Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. Conclusions 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

Efeito de técnicas de modulação inibitória da dor na eficácia analgésica do bloqueio anestésico do nervo alveolar inferior em pulpite irreversível: um ensaio clínico randomizado placebo controlado

“…Assim, várias estratégias têm sido investigadas para alcançar sucesso anestésico no tratamento endodôntico de pré-molares e molares inferiores com pulpite irreversível sintomática. Podemos destacar estudos que compararam diferentes anestésicos utilizados rotineiramente na odontologia Keiser, 2002;Fowler et al, 2016;Aggarwal;Miglani, 2017;Habib et al, 2022;Singhal et al, 2022).…”

“…Apenas três (15%) pacientes do grupo TENS e sete (35%) do grupo Placebo relataram algum nível de dor pós-operatória, sem diferença estatisticamente significativa entre os grupos (P > 0,05). A busca de estratégias para melhorar a taxa de sucesso do bloqueio do NAI é recorrente na literatura e envolve tipos de anestésicos Keiser, 2002;Fowler et al, 2016;Aggarwal;Miglani, 2017;Habib et al, 2022;Singhal et al, 2022), técnicas de anestesia (Kim, 1986 ;Nusstein et al, 2003;Click et al, 2015), uso de medicações analgésicas e anti-inflamatórios pré-operatórias (Lapidus et al, 2016;Só et al, 2023), terapia com laser de baixa intensidade Embora o risco de toxicidade anestésica seja baixo (Wadlund, 2017;Long et al, 2022), o presente estudo verificou que nenhum dos pacientes do grupo TENS necessitaram de complementação anestésica, achado este importante em reduzir a necessidade de mais anestesia e consequentemente maior volume de anestésico aplicado, evitando assim complicações (Aquilanti et al, 2022) e aumentando a segurança do procedimento. Esses resultados também podem ser levados em consideração em relação ao uso de AINEs no pré-operatório.…”