title: Combating inadequate anesthesia in periapical infections, with sodium bicarbonate: a clinical double blind study.
abstract: BACKGROUND
  Local anesthetics are generally much less effective when administered in inflamed tissues.
  
  
  OBJECTIVE
  This study was conducted to validate the addition of sodium bicarbonate in local anesthetics to increase its effectiveness as local infiltrations in teeth associated with periapical infections.
  
  
  METHODS
  Two hundred subjects requiring extraction of maxillary teeth with periapical infections were enrolled. These subjects were divided in two groups of 100 subjects each. One group received local infiltration with 2 % lignocaine and 1:80,000 adrenaline, and the other group received local infiltration with sodium bicarbonate as an adjunct to the above mentioned local anesthetic solution. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of local anesthetic solution. Data related to the onset of action of local anesthesia, pain experienced by the patient while undergoing extraction on two scales-"the visual analog scale and the verbal response scale", and any requirement of repeated injections during the procedure was recorded.
  
  
  RESULTS
  Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics did increase the efficacy of local anesthesia in inflamed tissues.
  
  
  CONCLUSIONS
  It has been observed in this study that the action of sodium bicarbonate in local anesthetics increases the pH levels of these solutions, thus possibly making them more effective in an acidic environment.
authors.affiliation: Padmashree Dr D Y Patil Dental College, Navi Mumbai, Maharashtra, India, drsavinagupta@hotmail.com.
authors.forename: Savina
authors.initials: S
authors.lastname: Gupta
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Mandlik
authors.forename: Mukul N
authors.initials: MN
authors.lastname: Padhye
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Kini
authors.forename: Shruti
authors.initials: S
authors.lastname: Kakkar
authors.forename: Abhinav Vijay
authors.initials: AV
authors.lastname: Hire
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003751:Dental Fistula / Q000150:complications; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D008437:Maxilla / Q000601:surgery; D010147:Pain Measurement / Q000379:methods; D010483:Periapical Diseases / Q000503:physiopathology*; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D014081:Tooth Extraction / Q000379:methods; D014098:Toothache / Q000150:complications; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D008012:Lidocaine; D004837:Epinephrine