Does the Combination of 3% Mepivacaine Plain Plus 2% Lidocaine with Epinephrine Improve Anesthesia and Reduce the Pain of Anesthetic Injection for the Inferior Alveolar Nerve Block? A Prospective, Randomized, Double-blind StudyJournal of Endodontics

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Authors
Emily Lammers, John Nusstein, Al Reader, Melissa Drum, Mike Beck, Sara Fowler
Year
2014
DOI
10.1016/j.joen.2014.04.015
Subject
Dentistry (all)

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Does the Combination of 3% Mepivacaine Plain Plus 2% Lidocaine with Epinephrine Improve Anesthesia and Reduce the Pain of Anesthetic Injection for the Inferior Alveolar Nerve Block? A Prospective, in ste

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No statistical differences in injection pain or onset times were found. Conclusions: The combination of 3% mehealth as determined by a written health history and oral questioning. Exclusion criteria

CONSORT Randomized Clinical Trialhttp://dx.doi.org/10.1016/j.joen.2014.04.015pivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of injection pain, onset time, and pulpal anesthetic success for the IAN block. (J Endod 2014;40:1287–1292) were as follows: younger than 18 or older than 65 years of age, American Society of

Anesthesiologists classification of II or greater, allergy to local anesthetics or sulfites, taking anymedications (analgesics, alcohol, antidepressant or antianxiety medications) that would alter perception of pain or metabolism of anesthetics within the last 48 hours, and inability to give informed consent. Women were questioned regarding pregnancy and were not allowed to participate if pregnant, suspected a pregnancy, trying to

From *The Ohio State University, †Division of Endodontics, The Ohio State University, and ‡Division of Oral Biology, The Ohio State University, Columbus, Ohio.

Currently Dr Lammers is in practice limited to endodontics in Sartell, Minnesota.

Address requests for reprints to Dr Al Reader, Graduate Endodontics, College of Dentistry, The Ohio State University, 305 West 12th Avenue, Columbus, OH 43210.

E-mail address: reader.2@osu.edu 0099-2399/$ - see front matter

Copyright ª 2014 American Association of Endodontists.icantly different (P > .05) between the 2 combinations.

Materials and Methods

One hundred adult subjects participated in this study. The subjects were in goodRandomized, Double-bl

Emily Lammers, DDS, MS,* John Nus

Melissa Drum, DDS, MS,† Mike Beck,

Abstract

Introduction: In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the pain of injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in

IAN blocks. Injection pain was also studied. Methods:

One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the pain of injection.

The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes.

Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes. Results: Success was not signif-JOE — Volume 40, Number 9, September 2014d Study in, DDS, MS,† Al Reader, DDS, MS,†

S, MA,‡ and Sara Fowler, DMD, MS†

Key Words

Inferior alveolar nerve block, injection pain, lidocaine with epinephrine, 3% mepivacaine

The inferior alveolar nerve (IAN) block does not always result in successful pulpalanesthesia (1). Failure rates of 17%–58% have been reported in experimental studies (1). Therefore, it would be advantageous to improve the success rate of the

IAN block.

Some clinicians initially administer 3% mepivacaine plain and then add 2% lidocaine with 1:100,000 epinephrine for IAN blocks (1). The rationale is that 3% mepivacaine has a higher pH because it does not contain epinephrine and has more anesthetic molecules than 2% lidocaine because of its higher concentration (1). In theory, using 3% mepivacaine initially would decrease the pain of injection, provide a quicker onset of anesthesia, increase anesthetic success, and possibly potentiate the effect of giving a second cartridge of 2% lidocaine with epinephrine for IAN blocks.

No objective study has combined 3% mepivacaine and 2% lidocaine with 1:100,000 epinephrine for IAN blocks. Therefore, the purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine with 1:100,000 epinephrine versus a combination of 2% lidocaine with 1:100,000 epinephrine/2% lidocaine with 1:100,000 epinephrine in IAN blocks in asymptomatic subjects. Injection pain of the IAN blocks was also studied.Combination of 3% Mepivacaine/2% Lidocaine (1:100,000 Epinephrine) for IAN Blocks 1287

CONSORT Randomized Clinical Trial become pregnant, or lactating. The Human Subjects Review Committee approved the study, and written informed consent was obtained from each subject.

The 100 blinded subjects randomly received 2 combination sets of

IAN blocks, either a cartridge of 3%mepivacaine (Carbocaine; Dentsply

Pharmaceutical, York, PA) followed by a cartridge of 2% lidocaine with 1:100,000 epinephrine (Xylocaine; Dentsply Pharmaceutical) or a cartridge of 2% lidocaine with 1:100,000 epinephrine followed by a second cartridge of 2% lidocaine with 1:100,000 epinephrine at 2 separate appointments spaced at least 1 week apart in a crossover design. With the crossover design, there were 200 combination sets of IAN blocks administered, and each subject served as his or her own control. An equal number of combination sets of IAN blocks were administered on the right side and the left side. The same side randomly chosen for the first set of injections was used again for the second set of injections. The test teeth chosen for the experiment were the first and second molars, first and second premolars, and central and lateral incisors.