title: Anesthetic efficacy of a combination of 0.9 M mannitol plus 68.8 mg of lidocaine with 50 μg epinephrine in inferior alveolar nerve blocks: a prospective randomized, single blind study.
abstract: The purpose of this prospective randomized, single blind study was to determine the anesthetic efficacy of 68.8 mg of lidocaine with 50 μg epinephrine compared to 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine and a 5-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine (1.72 mL) plus 0.9 M mannitol (3.28 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings), for each tooth, over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that the 5 mL-formulation of 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol was significantly better than the 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine for all teeth, except the lateral incisor. We concluded that adding 0.9 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol. However, the 0.9 M mannitol/lidocaine formulation would not provide 100% pulpal anesthesia for all the mandibular teeth.
authors.affiliation: Former Graduate Student in Endodontics, The Ohio State University, currently in practice limited to endodontics, Towson, Maryland.
authors.forename: Howard
authors.initials: H
authors.lastname: Cohen
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.forename: Melissa
authors.initials: M
authors.lastname: Drum
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
mesh_terms: D000293:Adolescent; D000328:Adult; D019162:Anesthetics, Combined; D000779:Anesthetics, Local / Q000009:adverse effects / Q000494:pharmacology*; D016009:Chi-Square Distribution; D018592:Cross-Over Studies; D003791:Dental Pulp Test; D004837:Epinephrine; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D008353:Mannitol / Q000009:adverse effects / Q000494:pharmacology*; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D014313:Trismus / Q000139:chemically induced; D055815:Young Adult
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008353:Mannitol; D008012:Lidocaine; D004837:Epinephrine