Buffered 1% Lidocaine with Epinephrine is as Effective as Non-buffered 2% Lidocaine with Epinephrine for Mandibular Nerve Block

Publication date: Available online 5 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Victor T. Warren, Anson G. Fisher, Eric M. Rivera, Pooja T. Saha, Blake Turner, Glenn Reside, Ceib Phillips, Raymond P. White
PurposeAssess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1/100k epinephrine (Epi) vs. non-buffered 2% lidocaine with 1/100k Epi.Subjects and MethodsWith an IRB approved randomized cross-over trial buffered 1% lidocaine with 1/100k Epi was compared to non-buffered 2% lidocaine with 1/100k Epi. After mandibular nerve block with 40mg. of buffered lidocaine or 80mg. of non-buffered lidocaine subjects reported responses at the mandibular 1^st molar and canine after cold and electrical pulp testing (EPT). Subjects also reported pain on injection with a 10pt Likert-type scale. Teeth were tested prior to nerve block and at 30 minute intervals until a positive response returned. Subjects two weeks later were tested with the alternate drug combinations. The same outcomes were assessed.Predictor variables were alternate drug formulations. Outcome variables were subjects' responses to cold and EPT stimulation of the mandibular 1^st molar and canine, and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank sum tests with Proc NPAR1WAY (SAS v 9.3, SAS Institute, Cary, NC). Significance was set at P<0.05.ResultsFifty-seven percent of subjects were female and 43% male. Seventy percent were Caucasian, 17% African American, 13% other ethnicity. Median age was 25 years(IQR 21,26y) with median body weight 140lbs.(IQR 120,155lbs.).Following the cold and EPT tests, the time to sensation return for the molar or canine was not statistically significant comparing the two drug formulations. Subjects reported significantly lower pain scores with the buffered drug vs. the non-buffered, P<0.01.ConclusionsAfter mandibular nerve block buffered 1% Lidocaine with Epi can produce similar clinical outcomes for duration of pulpal anesthesia as can non-buffered 2% lidocaine with Epi, and lower pain on injections, both a potential benefit to patients.



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