Buffered 1% Lidocaine With Epinephrine Is as Effective as Non-Buffered 2% Lidocaine With Epinephrine for Mandibular Nerve Block.
OBJECTIVE
To assess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2% lidocaine with 1:100,000 EPI.


METHODS
In a randomized cross-over trial approved by the institutional review board, buffered 1% lidocaine with 1:100,000 EPI was compared with non-buffered 2% lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than .05.


RESULTS
Fifty-seven percent of patients were women and 43% were men. Seventy percent were Caucasian, 17% were African American, and 13% had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P < .01).


CONCLUSIONS
After mandibular nerve block, buffered 1% lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2% lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.
Dental Student, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Victor T
VT
Warren
Dental Student, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Anson G
AG
Fisher
J.B. Freedland Distinguished Associate Professor, Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Eric M
EM
Rivera
Doctoral Student, Department of Biostatistics, Gillings School of Public Health, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Pooja T
PT
Saha
Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Blake
B
Turner
Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Glenn
G
Reside
Professor, Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Ceib
C
Phillips
Dalton L. McMichael Distinguished Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC. Electronic address: ray_white@dentistry.unc.edu.
Raymond P
RP
White
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002021:Buffers; D018592:Cross-Over Studies; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D009407:Nerve Block / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000779:Anesthetics, Local; D002021:Buffers; D008012:Lidocaine; D004837:Epinephrine