Volume of Anesthetic Agents and IANB Success: A Systematic Review

Abstract

The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?" Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67-3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.

Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review

“…34 Three studies reported that the dosage of anesthesia could affect the efficiency of anesthesia, in that a greater volume could increase anesthetic efficiency. [28][29][30] This is because a higher volume of the anesthetic agent may yield a higher concentration of the anesthetic agent in the pterygomandibular space. 29 Moreover, Al-Shayyab et al 35 found that many factors could affect the onset time and duration of action of local anesthesia, such as age, gender, and smoking status.…”

“…[21][22][23][24][25][26][27] The pooled outcomes for SOA showed that articaine resulted in shorter SOA than lidocaine, as shown in Figure 4A (SMD, 1.20; 95% CI, 0.50 to 1.89; P = .0007), but with high total heterogeneity (I 2 = 94%, P < .00001) and high heterogeneity for the 2L100 subgroup (I 2 = 95%, P < .00001), so we conducted a sensitivity analysis and found no obvious heterogeneity to change. According to the findings of 3 studies, [28][29][30] we knew a greater dosage could cause more anesthesia efficiency for lidocaine and articaine in LTME. Thus, the dosage used was likely the main cause of the remaining heterogeneity.…”

Comparative evaluation of anesthetic efficacy of 1.8 mL and 3.6 mL of articaine in irreversible pulpitis of the mandibular molar: A randomized clinical trial

“…Recently a systematic review concluded that increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of IANB in mandibular molars with irreversible pulpitis [28]. However, only a very few number of research references were included in this review.…”

Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: A randomized controlled clinical trial

“…Various factors such as the speed of injection, pressure during administration, injection site, pH, volume and temperature of the anesthetic solution have been attributed to the degree of pain associated with local anesthetic administration. 1 - 5 …”