title: Effect of Preoperative Pain on Inferior Alveolar Nerve Block.
abstract: The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.
authors.affiliation: Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Aggarwal
authors.affiliation: Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India.
authors.forename: Mamta
authors.initials: M
authors.lastname: Singla
authors.affiliation: Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India.
authors.forename: Arunajatesan
authors.initials: A
authors.lastname: Subbiya
authors.affiliation: Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India.
authors.forename: Paramasivam
authors.initials: P
authors.lastname: Vivekanandhan
authors.affiliation: Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India.
authors.forename: Ritu
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India.
authors.forename: Venkatachalam
authors.initials: V
authors.lastname: Prakash
authors.affiliation: Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India.
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Geethapriya
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D008875:Middle Aged; D008963:Molar / Q000473:pathology; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011671:Pulpitis / Q000503:physiopathology / Q000628:therapy; D018915:Root Canal Preparation / Q000379:methods; D013997:Time Factors; D014098:Toothache / Q000503:physiopathology*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine
keywords: Central sensitization; Hyperalgesia; Inferior alveolar nerve block; Irreversible pulpitis; Preoperative pain