Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of adding dexmedetomidine to lidocaine to enhance inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis: double-blind randomized clinical trial

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This randomized, double-blind study was to determine whether dexmedetomidine (DEX) helped to improve the inferior alveolar nerve block’s (IANB) success in patients with asymptomatic irreversible pulpitis (AIP). We hypothesized that adding DEX to lidocaine enhances the anesthetic effect of lidocaine to a satisfactory level by localizing anesthesia in a safer way.

Materials and methods

Fifty adult volunteers with AIP in a first or second mandibular molar were randomly assigned to two groups to either receive 1.4 ml 2% plain lidocaine or 1.4 ml 2% lidocaine + 0.4 ml (40 μg) DEX, for standard IANB injection. Access cavity preparation initiated 10–15 min postinjection when the patient reported lower lip numbness and had two negative electric pulp tests (EPTs) with 5-min intervals. Heft-Parker visual analog scale (VAS) was used to report pain in three steps: during caries and dentin removal, access cavity preparation, and canal working-length determinations; EPT and VAS were analyzed by Friedman test; and success rates were analyzed by Mann–Whitney and Fisher’s exact test using SPSS software version 20.

Results

Successful anesthesia (defined as no or mild pain during any of steps and no need for additional injection) is obtained in 12% of patients in the lidocaine group, while DEX-lidocaine group increased the success rate of IANB to 72% (p-value = 0.0001).

Conclusions

DEX significantly increases the anesthetic effect of lidocaine in IANB injection in patients with AIP.

Clinical relevance

DEX would be a safe adjunct to lidocaine to increase the success rate in IANB and could be a suitable alternative for conventional vasoconstrictors in sensitive groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aggarwal V, Singla M, Kabi D (2010) Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod 1;36(3):375–8. https://doi.org/10.1016/j.joen.2009.11.010

  2. Noguera-Gonzalez D, Cerda-Cristerna BI, Chavarria-Bolaños D, Flores-Reyes H, Pozos-Guillen A (2013) Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Int J Endod 46(11):1056–62. https://doi.org/10.1111/iej.12099

    Article  Google Scholar 

  3. Malamed SF (2019) Handbook of Local Anesthesia-E-Book. Elsevier health sciences. 240

  4. Mellor AC, Dorman ML, Girdler NM (2005) The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis. Int J Endod 38(11):789–792. https://doi.org/10.1111/j.1365-2591.2005.01015

    Article  Google Scholar 

  5. Mousavi SA, Sadaghiani L, Shahnaseri S, Zandian A, Farnell DJ, Vianna ME (2020) Effect of magnesium sulphate added to lidocaine on inferior alveolar nerve block success in patients with symptoms of irreversible pulpitis: a prospective, randomized clinical trial. Int J Endod 53(2):145–153. https://doi.org/10.1111/iej.13186

    Article  Google Scholar 

  6. Parirokh M, Sadr S, Nakhaee N, Abbott PV, Askarifard S (2014) Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial. Int J Endod 47(10):926–933. https://doi.org/10.1111/iej.12236

    Article  Google Scholar 

  7. Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T (2008) Dexmedetomidine enhances the local anesthetic action of lidocaine via an α-2A adrenoceptor. J Anesth Analg 1;107(1):96–101. https://doi.org/10.1213/ane.0b013e318176be73

  8. Ouchi K, Sugiyama K (2016) Dexmedetomidine dose dependently enhances the local anesthetic action of lidocaine in inferior alveolar nerve block: a randomized double-blind study. Reg Anesth Pain Med 1;41(3):348–55. https://doi.org/10.1097/AAP.0000000000000380

  9. Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, Gerner P, Brummett CM (2014) Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: A single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med 39(1):37–47. https://doi.org/10.1097/AAP.0000000000000033

    Article  PubMed  Google Scholar 

  10. Aggarwal V, Singla M, Rizvi A, Miglani S (2011) Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis. J Endod 1;37(4):445–9. https://doi.org/10.1016/j.joen.2011.01.016

  11. Akhlaghi NM, Hormozi B, Abbott PV, Khalilak Z (2016) Efficacy of ketorolac buccal infiltrations and inferior alveolar nerve blocks in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod 1;42(5):691–5. https://doi.org/10.1016/j.joen.2016.02.003

  12. Cook O, Nusstein J, Drum M, Fowler S, Reader A, Draper J (2018) Anesthetic efficacy of a combination of 4% prilocaine/2% lidocaine with epinephrine for the inferior alveolar nerve block: a prospective, randomized, double-blind study. J Endod 1;44(5):683–8. https://doi.org/10.1016/j.joen.2018.01.004

  13. Aggarwal V, Singla M, Miglani S, Kohli S (2019) Efficacy of articaine versus lidocaine administered as supplementary intraligamentary injection after a failed inferior alveolar nerve block: a randomized double-blind study. J Endod 1;45(1):1–5. https://doi.org/10.1016/j.joen.2018.09.012

  14. Oleson M, Drum M, Reader A, Nusstein J, Beck M (2010) Effect of preoperative ibuprofen on the success of the inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 1;36(3):379–82. https://doi.org/10.1016/j.joen.2009.12.030

  15. Ice CJ, Personett HA, Frazee EN, Dierkhising RA, Kashyap R, Oeckler RA (2016) Risk factors for dexmedetomidine-associated hemodynamic instability in noncardiac intensive care unit patients. Anesth Analg 122(2):462–469. https://doi.org/10.1213/ANE.0000000000001125

    Article  PubMed  Google Scholar 

  16. Gerlach AT, Blais DM, Jones GM, Burcham PK, Stawicki SP, Cook CH, Murphy CV (2016) Predictors of dexmedetomidine-associated hypotension in critically ill patients. Int J Crit IIIn Inj Sci 6(3):109–114. https://doi.org/10.4103/2229-5151.190656

    Article  Google Scholar 

  17. Yamane A, Higuchi H, Tomoyasu Y, Ishii-Maruhama M, Maeda S, Miyawaki T (2015) Effect of dexmedetomidine injected into the oral mucosa in combination with lidocaine on local anesthetic potency in humans: a crossover double-blind study. J Oral Maxillofac Surg 1;73(4):616–21. https://doi.org/10.1016/j.joms.2014.09.029

  18. Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E (2010) High concentrations of dexmedetomidine inhibit compound action potentials in frog sciatic nerves without α2 adrenoceptor activation. Br J Pharmacol 160(7):1662–1676. https://doi.org/10.1111/j.1476-5381.2010.00833.x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Singh V, Thepra M, Kirti S, Kumar P, Priya K (2018) Dexmedetomidine as an additive to local anesthesia: a step to development in dentistry. J Oral Maxillofac Surg 1;76(10):2091-e1. https://doi.org/10.1016/j.joms.2018.05.037

  20. Ouchi K, Koga Y, Nakao S, Sugiyama K (2014) Dexmedetomidine dose-dependently enhances local anesthetic action of lidocaine. J Oral Maxillofac Surg 1;72(3):474–80. https://doi.org/10.1016/j.joms.2013.09.038

  21. Cheung CW, Ng KF, Liu J, Yuen MY, Ho MH, Irwin MG (2011) Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. Br J Anaesth 1;107(3):430–7. https://doi.org/10.1093/bja/aer164

  22. Mahmoud M, Mason KP (2015) Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth 1;115(2):171–82. https://doi.org/10.1093/bja/aev226

  23. Devasya A, Sarpangala M (2015) Dexmedetomidine: a review of a newer sedative in dentistry. J Clin Pediatr Dent 39(5):401–9. https://doi.org/10.17796/1053-4628-39.5.401

  24. Memis D, Turan A, Karamanloglu B, Pamukçu Z, Kurt I (2004) Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. J Anesth Analg 1;98(3):835–40. https://doi.org/10.1213/01.ANE.0000100680.77978.66

  25. Upadhyay SP, Samanth U, Tellicherry S, Mallick P (2015) Role of intravenous dexmedetomidine in prolonging postoperative analgesia and quality of block following spinal anaesthesia. A Systemic Review and Update. J Pain Relief 4(175):2. https://doi.org/10.4172/2167-0846.1000175

  26. Abdallah FW, Abrishami A, Brull R (2013) The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis. J Anesth Analg 1;117(1):271–8. https://doi.org/10.1213/ANE.0b013e318290c566

  27. Abdelhamid AM, Mahmoud AA, Abdelhaq MM, Yasin HM, Bayoumi AS (2016) Dexmedetomidine as an additive to local anesthetics compared with intravenous dexmedetomidine in peribulbar block for cataract surgery. Saudi J Anaesth 10(1):50. https://doi.org/10.4103/2F1658-354X.169475

    Article  PubMed  PubMed Central  Google Scholar 

  28. Moustafa AM, Atalla H, Koptan HM (2015) Comparison of dexmedetomidine, lidocaine, and their combination in attenuation of cardiovascular and catecholamine responses to tracheal extubation and anesthesia emergence in hypertensive patients. Research and Opinion in Anesthesia and Intensive Care 1;2(2):1. https://doi.org/10.4103/roaic.roaic_37_19

  29. Catterall WA (2002) Molecular mechanisms of gating and drug block of sodium channels. Novartis Found Symp 241:206–218. https://doi.org/10.1002/0470846682.ch14

    Article  PubMed  Google Scholar 

  30. Gertler R, Brown HC, Mitchell DH, Silvius EN (2001) Dexmedetomidine: a novel sedative-analgesic agent. Proc Bayl Univ Med Cent https://doi.org/10.1080/0899828011927725

  31. Dalkilic N, Tuncer S, Burat I (2015) Dexmedetomidine augments the effect of lidocaine: power spectrum and nerve conduction velocity distribution study. BMC anesthesiol 15(1):1–8. https://doi.org/10.1186/s12871-015-0009-9

    Article  Google Scholar 

  32. Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M (2010) Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol| EJA 1;27(3):280–4. https://doi.org/10.1097/EJA.0b013e3283347c15

  33. Ouchi K (2020) Dexmedetomidine 2 ppm is appropriate for the enhancement effect of local anesthetic action of lidocaine in inferior alveolar nerve block: a preliminary, randomized cross-over study. Clin J Pain 36(8):618–625. https://doi.org/10.1097/AJP.0000000000000839

    Article  PubMed  Google Scholar 

  34. Nalawade SH, Nilesh K, Kumar CM, Punde PA, Patil PB (2021) A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1: 200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars. National Journal of Maxillofacial Surgery 12(2):255. https://doi.org/10.4103/2Fnjms.NJMS_7_20

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to the Endodontics Department, Tehran Islamic Azad University of Medical Sciences, Dental School, for helping us to convey our study.

Funding

This study was self-funded.

Author information

Author notes

  1. Zahra Vahedi

    Present address: Endodontics Department, Dental School, Tehran Islamic Azad University of Medical Sciences, 1946853314, Tehran, Iran

Authors and Affiliations

  1. Endodontics Department, Dental School, Tehran Islamic Azad University of Medical Sciences, 1946853314, Tehran, Iran

    Amirabbas Moshari

  2. Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammadreza Moshari

Authors
  1. Zahra Vahedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amirabbas Moshari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammadreza Moshari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammadreza Moshari.

Ethics declarations

Ethics approval

This article was approved by the Institutional Review Board (ethics committee reference number: IR.IAU.DENTAL.REC.1396, 7). It was registered at the Iranian Registry of Clinical Trials (IRCT), Clinical Trials Registry: IRCT20150815023620N8. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vahedi, Z., Moshari, A. & Moshari, M. Efficacy of adding dexmedetomidine to lidocaine to enhance inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis: double-blind randomized clinical trial. Clin Oral Invest 26, 4727–4734 (2022). https://doi.org/10.1007/s00784-022-04436-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04436-7

Keywords

Search

Navigation