Featured research in the qualitative analysis and its characteristics (all randomized controlled trials—RCTs).
| Author | Aim | Materials and methods | Outcome |
|---|---|---|---|
| Singh SK, et al. 2024 [10] | To evaluate the effect of premedication on the success rate of IANB in tobacco-chewing (TC) patients with symptomatic IP. | 160 patients over 9 months were enrolled and divided into two main groups: smokers (study group) and non-smokers (control group). Each group was further split into two subgroups based on whether they received a premedication of 600 mg ibuprofen one hour prior to the procedure.All patients were administered a 2% lidocaine solution with epinephrine for the IANB. The success of pulpal anesthesia was confirmed using both electric pulp testing and cold spray application. Pain experienced during the NEI was measured on a 10-point visual analog scale (VAS), with no reported pain indicating effective anesthesia. | The research demonstrated that taking ibuprofen before the procedure enhanced the effectiveness of the IANB in both TC and non-tobacco-chewing (NTC) patients. Despite this improvement being more pronounced in the NTC group, the difference in anesthetic success between the two groups was not statistically meaningful. Additionally, no definitive link could be drawn between nicotine use and the effectiveness of the premedication. |
| de Oliveira JP, et al. 2024 [39] | To investigate how preoperative use of ibuprofen and ibuprofen-arginine affects the success of IANB anesthesia in patients suffering from IP. It also examines how patients’ pain and anxiety levels before the procedure impact the effectiveness of the IANB. | 150 individuals with IP were randomly divided into three groups, each receiving a different treatment 30 minutes prior to the administration of IANB: 600 mg ibuprofen, 1,155 mg ibuprofen-arginine, or a placebo.Anxiety levels before the procedure were evaluated using the Modified Dental Anxiety Scale, and pain intensity was recorded using the Heft-Parker visual analog scale (HP VAS). | Patients who received ibuprofen showed a 62% success rate with the IANB, while those given ibuprofen-arginine had a higher rate of 78%. In contrast, only 34% of patients in the placebo group achieved successful anesthesia. Moreover, lower pre-treatment pain and anxiety were linked to improved anesthetic outcomes. |
| Bidar M, et al. 2017 [41] | To evaluate the effect of preoperative oral administration of ibuprofen or dexamethasone on the success rate of IANB in patients with symptomatic IP. | 78 patients diagnosed with IP were randomly assigned to three groups (26 patients each): placebo, ibuprofen (400 mg), dexamethasone (4 mg).Medications were administered orally one hour prior to performing local anesthesia. Anesthetic success was defined as no or mild pain during the endodontic procedure. | The success rates of IANB were: placebo: 38.5%, ibuprofen: 73.1%, dexamethasone: 80.8%Both ibuprofen and dexamethasone significantly improved anesthetic success compared to placebo; however, no significant difference was observed between the two medications. |
| Riaz M, et al. 2023 [19] | To assess whether preoperative oral administration of analgesics (diclofenac sodium, piroxicam, or tramadol) enhances the efficacy of IANB in patients with symptomatic IP in mandibular molars. | 120 patients with IP were randomly assigned to four groups:
Medications were administered orally one hour prior to IANB using 2% lidocaine with 1:100,000 epinephrine. Pain levels were measured using the HP VAS before and after anesthesia. Anesthetic success was defined as no or mild pain during the root canal procedure. | All analgesic groups demonstrated significantly higher IANB success rates compared to the control group (p < 0.05).Success rates were: piroxicam 93.3%, tramadol 86.6%, diclofenac sodium 66.6%, and control 30%.No significant difference was found among the three analgesic groups (p > 0.05).These findings suggest that preoperative administration of analgesics, particularly piroxicam, can enhance the efficacy of IANB in patients with IP. |
| Elnaghy AM, et al. 2023 [36] | To compare the effects of preoperative administration of tramadol (50 mg and 100 mg), ibuprofen (600 mg), and a combination of ibuprofen (600 mg) with acetaminophen (1,000 mg) on the anesthetic efficacy of IANB in patients with symptomatic IP. | Patients diagnosed with symptomatic IP in mandibular molars were randomly assigned to receive one of the following oral premedications:
Medications were administered one hour prior to performing the IANB using 2% lidocaine with 1:100,000 epinephrine. Anesthetic success was defined as no or mild pain during endodontic access, assessed using the HP VAS. | Premedication with tramadol 100 mg significantly increased the success rate of IANB to 62% compared to the other groups (p < 0.05).The success rates for ibuprofen, ibuprofen/acetaminophen, and tramadol 50 mg groups were not significantly different from each other (p > 0.05).These findings suggest that a higher dose of tramadol (100 mg) as premedication can enhance the anesthetic efficacy of IANB in patients with symptomatic IP. |
| Rodrigues GA, et al. 2024 [18] | To evaluate the impact of preemptive administration of dexamethasone (corticosteroid) and diclofenac potassium (NSAID) on the success rate of IANB anesthesia and on postoperative pain levels in patients undergoing endodontic treatment for mandibular molars with symptomatic IP. | 84 patients with symptomatic IP were randomly assigned to receive one of the following oral medications 60 minutes before IANB with 4% articaine (1:200,000 epinephrine):
Anesthetic success was assessed 15 minutes post-injection using a cold thermal test. Postoperative pain was evaluated at 6, 12, 24, 48, and 72 hours using a modified Numerical Rating Scale (mNRS). | Anesthetic success rates were significantly higher in the dexamethasone (39.3%) and diclofenac (21.4%) groups compared to the placebo group (3.6%) (p < 0.001).At 6 hours post-treatment, dexamethasone significantly reduced pain compared to placebo (p < 0.001), while diclofenac showed intermediate results without a significant difference from either dexamethasone or placebo.At 24, 48, and 72 hours, both dexamethasone and diclofenac groups experienced significantly lower pain levels compared to the placebo group (p < 0.001). |
| Fullmer S, et al. 2014 [33] | To evaluate whether preoperative administration of a combination of acetaminophen and hydrocodone enhances the anesthetic efficacy of IANB in patients with symptomatic IP in mandibular posterior teeth. | 100 patients with symptomatic IP in a mandibular posterior tooth were randomly assigned to receive either:
Medications were administered orally 60 minutes prior to the administration of a conventional IANB. Endodontic access was initiated 15 minutes after the block. Anesthetic success was defined as no or mild pain during pulpal access or instrumentation, assessed using a VAS. | The success rate for the IANB was 32% in the acetaminophen/hydrocodone group and 28% in the placebo group.The difference between the two groups was not statistically significant (p = 0.662). These findings suggest that preoperative administration of 1,000 mg acetaminophen combined with 10 mg hydrocodone does not significantly improve the anesthetic efficacy of the IANB in patients with symptomatic IP. |
| Kumar U, et al. 2021 [42] | To evaluate whether preoperative administration of paracetamol (acetaminophen) or ketorolac enhances the anesthetic success of the IANB in patients with symptomatic IP. | 134 patients with symptomatic IP in mandibular molars were randomly assigned to one of three groups:
Medications were administered orally one hour prior to performing the IANB using 2% lidocaine with 1:200,000 adrenaline. Anesthetic success was defined as no or mild pain during access cavity preparation and canal instrumentation, assessed using the HP VAS. | The success rates of IANB were:Placebo: 29%Paracetamol: 33%Ketorolac: 43%No statistically significant difference was found among the three groups (p > 0.05).These findings suggest that preoperative administration of paracetamol or ketorolac does not significantly improve the anesthetic efficacy of IANB in patients with symptomatic IP. |
| Hegde V, et al. 2023 [30] | To compare the anesthetic success of IANBs using 2% lidocaine in mandibular molars with symptomatic IP following preoperative oral administration of prednisolone, dexamethasone, ketorolac, or placebo. | 184 patients diagnosed with IP in mandibular molars were randomly assigned to receive one of the following oral medications 60 minutes before IANB:
The success of anesthesia was clinically confirmed when pain was absent during endodontic access or instrumentation. | The success rates of IANB were:
All three medications significantly increased anesthetic success compared to placebo (p < 0.05), with no significant differences among the active treatment groups. |
| Saha SG, et al. 2016 [16] | To evaluate the impact of preoperative oral administration of ketorolac (10 mg), diclofenac potassium (50 mg), or placebo on the anesthetic efficacy of IANB in patients with symptomatic IP. | 150 adult patients with symptomatic irreversible pulpitis in mandibular molars. Participants were randomly assigned to three groups receiving, one hour before inferior alveolar nerve block (IANB) with 2% lidocaine and epinephrine:
Pain during cavity preparation and canal instrumentation was assessed using the modified Heft-Parker visual analog scale (VAS), with anesthetic success defined as no pain or only mild pain. | All patients showed a significant reduction in pain after the IANB. However, anesthetic success was highest in the Ketorolac group, followed by the Diclofenac group, with the placebo group showing the lowest success. The study concluded that oral premedication with 10 mg Ketorolac significantly increases the likelihood of achieving effective anesthesia in patients with symptomatic irreversible pulpitis. |
| Elnaghy AM, et al. 2023 [43] | To evaluate the impact of preoperative oral administration of meloxicam, ketorolac, dexamethasone, or ibuprofen on the anesthetic success of IANB in patients with symptomatic IP in mandibular molars. | 250 emergency patients with symptomatic IP in a mandibular first or second molar were randomly assigned to receive one of the following oral medications 60 minutes before IANB:
Anesthetic success was defined as no or mild pain during access cavity preparation and root canal instrumentation, measured using the HP VAS. | The success rates for IANB were:
All active premedications significantly improved anesthetic success compared to placebo (p < 0.05), with no significant differences among the active treatment groups (p > 0.05). These findings suggest that preoperative administration of meloxicam, ketorolac, dexamethasone, or ibuprofen enhances the efficacy of IANB in patients with symptomatic IP. |
| Nivedha V, et al. 2020 [45] | To assess the effectiveness of preoperative oral ketorolac tromethamine in managing intraoperative and postoperative pain during single-visit root canal treatment of mandibular molars with acute IP. | 126 patients with acute IP received 10 mg of oral ketorolac tromethamine prior to local anesthesia. Two local anesthetics were used: 2% lignocaine with 1:80,000 adrenaline and 4% articaine with 1:100,000 adrenaline. Three irrigation solutions were employed: saline, 3% sodium hypochlorite, and dexamethasone. Intraoperative pain was measured using VAS, and postoperative pain incidence was recorded. | Mean intraoperative pain scores were similar between the lignocaine (4.33 ± 2.58) and articaine (4.22 ± 2.88) groups.Postoperative pain incidence was significantly lower in the lignocaine group (16.7%) compared to the articaine group (49.2%) (p = 0.000).Preoperative ketorolac did not significantly reduce intraoperative pain but was effective in controlling postoperative pain when used with lignocaine anesthesia.These findings suggest that while preoperative ketorolac may not impact intraoperative pain levels, it can effectively reduce postoperative pain, particularly when combined with lignocaine as the local anesthetic. |
| Aggarwal V, et al. 2021 [44] | To evaluate the effect of preoperative intraligamentary injections of dexamethasone or diclofenac sodium on the anesthetic efficacy of 2% lidocaine administered via IANB in patients with symptomatic IP in mandibular molars. | 117 patients with symptomatic IP in mandibular molars were randomly assigned to receive an intraligamentary injection of one of the following solutions:
Thirty minutes after the intraligamentary injection, all patients received an IANB using 2% lidocaine with 1:80,000 epinephrine. Anesthetic success was defined as no or mild pain during root canal access preparation and instrumentation, assessed using the HP VAS. | The anesthetic success rates were:
The dexamethasone group demonstrated a significantly higher success rate compared to both the diclofenac sodium and control groups (p < 0.001). No significant differences were observed between the diclofenac sodium and control groups. These findings suggest that preoperative intraligamentary injection of dexamethasone can significantly enhance the anesthetic success of IANB with 2% lidocaine. |
TC: tobacco-chewing; NTC: non-tobacco-chewing; IANB: inferior alveolar nerve block; NEI: needle electrode insertion; IP: Irreversible pulpitis; VAS: visual analog scale; HP VAS: Heft-Parker visual analog scale; NSAID: non-steroidal anti-inflammatory drug.