title: Evaluation of the effect of locally administered amitriptyline gel as adjunct to local anesthetics in irreversible pulpitis pain.
abstract: BACKGROUND
  Amitriptyline is one of the most common tricyclic antidepressants, which binds to pain sensory nerve fibers close to the sodium channel; hence, it could interact to some degree with receptors of local anesthetics. This study was designed to assess the additional analgesic effects of 2% Amitriptyline local gel administration in irreversible pulpitis pain of the molars.
  
  
  METHODS
  This study was a randomized, double-blind clinical trial that was performed on 56 consented adult patients who did not receive enough analgesia after a lidocaine nerve block for their tooth pulpitis pain. Patients were treated with 0.2 ml of either 2% amitriptyline or placebo, which was directly injected into their mandibular molar pulp chamber after they had received two routine lidocaine injections. Patients were asked to score their pain as a mark on a 10-cm Visual Analogue Scale (VAS) at different timepoints: 0 (just before gel administration), 1, 3, 5, 7, and 9 minutes after the treatments.
  
  
  RESULTS
  There was a 92.5% decrease in VAS scores of patients 9 minutes after amitriptyline administration compared to Time 0, while in the placebo group this difference was only 13.5%. Further, in the amitriptyline group, the VAS score at all timepoints was statistically different from Time 0 (P < 0.01). The overall pain reduction and its trend was significantly higher in the amitriptyline group compared with the placebo group (P < 0.001).
  
  
  CONCLUSIONS
  Inter-pulp space administration of amitriptyline 2% gel for completing analgesia in irreversible pulpitis pain could be effective and useful as a conjunctive therapy to injections of local anesthetics.
authors.affiliation: Department of Pharmacology, Babol University of Medical Sciences, Babol, Iran. moghadamnia@yahoo.com
authors.forename: A A
authors.initials: AA
authors.lastname: Moghadamnia
authors.forename: M
authors.initials: M
authors.lastname: Partovi
authors.forename: I
authors.initials: I
authors.lastname: Mohammadianfar
authors.forename: Z
authors.initials: Z
authors.lastname: Madani
authors.forename: E
authors.initials: E
authors.lastname: Zabihi
authors.forename: M R
authors.initials: MR
authors.lastname: Hamidi
authors.forename: M
authors.initials: M
authors.lastname: Baradaran