title: Efficacy of Ketorolac Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial.
abstract: BACKGROUND
  The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine whether ketorolac buccal infiltrations (BIs) helped to improve the success of inferior alveolar nerve blocks (IANBs) in patients with acute irreversible pulpitis (AIP).
  
  
  METHODS
  Forty adult volunteers with AIP in a mandibular molar were included in this study. Patients were instructed to evaluate their pain by using a Heft-Parker visual analog scale. They were randomly divided into 2 groups (n = 20). All patients received standard IANB injection and after that a BI of 4% articaine with 1:100,000 epinephrine. After 5 minutes, 20 patients received a BI of 30 mg/mL ketorolac, and the other received a BI of normal saline (control group). Endodontic access cavity preparation (ACP) was initiated 15 minutes after the IANB when the patient reported lip numbness and had 2 electric pulp tests with no responses. The patient's pain during caries and dentin removal, ACP, and canal length measurements (CLM) was recorded by using Heft-Parker visual analog scale. Successful anesthesia was defined as no or mild pain during any of these steps, without the need for additional injection. Data were statistically analyzed by using Mann-Whitney U and χ(2) tests.
  
  
  RESULTS
  Successful anesthesia after an IANB plus BI of articaine was obtained in 15% of patients in the control group at the end of CLM. Adding BI of ketorolac significantly increased the success rate to 40% (P < .05). Patient's pain during ACP and CLM was significantly lower in the ketorolac group (P < .05).
  
  
  CONCLUSIONS
  Ketorolac BI can increase the success rate of anesthesia after IANB and BI with articaine in patients with AIP.
authors.affiliation: Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran.
authors.forename: Nahid Mohammadzadeh
authors.initials: NM
authors.lastname: Akhlaghi
authors.affiliation: Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran.
authors.forename: Behnoush
authors.initials: B
authors.lastname: Hormozi
authors.affiliation: Department of Endodontics, School of Dentistry, University of Western Australia, Crawley, Perth, Western Australia.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Abbott
authors.affiliation: Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran. Electronic address: z_khalilak@dentaliau.ac.ir.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Khalilak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods*; D002355:Carticaine / Q000008:administration & dosage; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D007492:Iran; D020910:Ketorolac / Q000008:administration & dosage*; D008046:Lip / Q000187:drug effects; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D008875:Middle Aged; D008963:Molar / Q000187:drug effects / Q000294:innervation; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011671:Pulpitis / Q000628:therapy*; D018915:Root Canal Preparation / Q000379:methods; D012965:Sodium Chloride / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D012965:Sodium Chloride; D002355:Carticaine; D004837:Epinephrine; D020910:Ketorolac
keywords: Anesthesia; inferior alveolar nerve block; irreversible pulpitis; ketorolac