title: Effect of Oral Premedication on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Double-Blind, Randomized Controlled Clinical Trial.
abstract: BACKGROUND
  It is generally accepted that achieving complete anaesthesia with an Inferior Alveolar Nerve Block (IANB) in mandibular molars with symptomatic irreversible pulpitis is more challenging than for other teeth. Therefore, administration of Non-Steroidal Anti-Inflammatory Agents (NSAIDs) 1 hour prior to anaesthetic administration has been proposed as a means to increase the efficacy of the IANB in such patients.
  
  
  OBJECTIVE
  The purpose of this prospective, double-blind, randomized clinical trial was to determine the effect of administration of oral premedication with ketorolac (KETO) and diclofenac potassium (DP) on the efficacy of IANB in patients with irreversible pulpitis.
  
  
  METHODS
  One hundred and fifty patients with irreversible pulpitis were evaluated preoperatively for pain using Heft Parker visual analogue scale, after which they were randomly divided into three groups. The subjects received identical tablets of ketorolac, diclofenac pottasium or cellulose powder (placebo), 1 hour prior to administration of IANB with 2% lidocaine containing 1:200 000 epinephrine. Lip numbness as well as positive and negative responses to cold test were ascertained. Additionally pain score of each patient was recorded during cavity preparation and root canal instrumentation. Success was defined as the absence of pain or mild pain based on the visual analog scale readings. The data was analysed using One-Way Anova, Post-Hoc Tukey pair wise, Paired T - Test and chi-square test. Trial Registery Number is 4722/2015 for this clinical trial study.
  
  
  RESULTS
  There were no significant differences with respect to age (p =0.098), gender (p = 0.801) and pre-VAS score (DP-KETO p=0.645, PLAC-KETO p =0.964, PLAC-DP p = 0.801) between the three groups. All patients had subjective lip anaesthesia with the IAN blocks. Patients of all the three groups reported a significant decrease in active pain after local anaesthesia (p< 0.05). The post injection VAS Score was least in group 1 (KETO) followed by group II (DP) & maximum in group III (PLACEBO).
  
  
  CONCLUSIONS
  Oral pre-medication with 10 mg KETO resulted in significantly higher percentage of successful inferior alveolar block in patients with irreversible pulpitis than pre-medication with 50 mg DP & PLAC.
authors.affiliation: Professor and HOD, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Suparna Ganguly
authors.initials: SG
authors.lastname: Saha
authors.affiliation: Post Graduate Student, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Rau, Indore, Madhya Pradesh, India .
authors.forename: Sohini
authors.initials: S
authors.lastname: Jain
authors.affiliation: Senior Lecturer, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Rau, Indore, Madhya Pradesh, India .
authors.forename: Sandeep
authors.initials: S
authors.lastname: Dubey
authors.affiliation: Senior Lecturer, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Rau, Indore, Madhya Pradesh, India .
authors.forename: Shubham
authors.initials: S
authors.lastname: Kala
authors.affiliation: Reader, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Rau, Indore, Madhya Pradesh, India .
authors.forename: Abhinav
authors.initials: A
authors.lastname: Misuriya
authors.affiliation: Reader, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Rau, Indore, Madhya Pradesh, India .
authors.forename: Devendra
authors.initials: D
authors.lastname: Kataria
keywords: Local anesthesia; Pain; Visual analogue scale