Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Assessment of the effect of premedication on the success of inferior alveolar nerve block in tobacco chewing patients with symptomatic irreversible pulpitis: a randomized control trial

  • Sanjeev Kumar Singh (Department of Dentistry, SMMH Government Medical College) ;
  • Simith Yadav (Department of Dentistry, Government Medical College) ;
  • Amit Kumar (Santosh Dental College) ;
  • Harmurti Singh (Department of Dentistry, Government Medical College) ;
  • Hena Rahman (Department of Dentistry, Government Medical College) ;
  • Madan Mohan Niranjan (Department of Dentistry, Government Medical College) ;
  • Manika Jindal Mittel (Inderprastha Dental College & Hospital) ;
  • Mohit Wadhawan (Department of Dentistry, SMMH Government Medical College)
  • Received : 2024.06.02
  • Accepted : 2024.08.06
  • Published : 2024.10.01
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Abstract

Background: This study aimed to evaluate and compare the efficacy of oral premedication with ibuprofen on the anesthetic efficacy of inferior alveolar nerve block (IANB) using 2% lignocaine and 1:100000 epinephrine in tobacco-chewing (TC) and non-tobacco-chewing (NTC) patients with symptomatic irreversible pulpitis (SIP) during nonsurgical endodontic intervention (NEI). Methods: This multicenter, prospective, double-blind, two-arm parallel-group randomized controlled trial involving 160 patients was conducted for a period of 9 months. The patients were classified into the study (TC patients) and control (NTC patients) groups, which were subdivided into two subgroups 1 hour before the procedure based on oral premedication with tab ibuprofen 600 mg. Nicotine dependence was assessed using the Modified Fagerstrom Tolerance Nicotine Scale. Patients were administered an IANB injection of 2% lignocaine containing epinephrine 1:100000 after premedication. Pulpal anesthesia before NEI was confirmed using electric pulp testing and cold spraying. Patients rated their pain on the 10-point visual analog scale (VAS) during NEI thrice at the dentin, pulp, and instrumentation levels. No pain at each level indicated the success of anesthesia. Results: The success and failure rates did not differ between the premedication and non-premedication subgroups in the TC or NTC groups (P > 0.05). However, the success rate was higher in the premedication subgroup of the NTC group (52.5%) than in the TC group (45%). Most patients with premedication experienced failure at the instrumentation level, whereas patients in the non-premedication group experienced pain at the dentin level. Failure rates of IANB did not differ significantly at different levels between the groups (P > 0.05). The mean VAS scores differed significantly at the dentin level in both groups, with lower values in the premedication group (P < 0.05). Conclusions: The efficacy of ibuprofen premedication with IANB during NEI did not differ significantly between the TC and NTC patients with SIP. The effect of premedication was more significant in the NTC group than in the TC group. A causal relationship between nicotine consumption and the success of premedication could not be established, and further studies are required to validate the results of the present study.

Keywords

Acknowledgement

We thank all study participants for their active contributions to the present study. We are also grateful to the statisticians for their kind support and assistance in the data analysis. We affirm that we have no financial affiliation (e.g., employment, direct payment, stock holdings, retainers, consultantships, patent licensing arrangements, or honoraria) or involvement with any commercial organization with direct financial interest in the subject or materials discussed in this manuscript, nor have any such arrangements existed in the past three years.

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