Evaluating the pain at site, onset of action, duration and anesthetic efficacy of conventional, buffered lidocaine, and precooled lidocaine with intraoral cryotherapy application in patients with symptomatic irreversible pulpitis: A clinical study

Aim: Injection pain and incomplete anesthesia can lead to procedural failure, causing fear and anxiety among patients. The aim of the study was to compare and evaluate pain at the site, the onset of action, duration, anesthetic efficacy, and success rates of conventional, buffered, and precooled 2% lidocaine of an inferior alveolar nerve block (IANB) in symptomatic irreversible pulpitis (SIP). Materials and Methodology: In this double-blind, randomized clinical trial, 45 patients with deep carious lesions having moderate-to-severe pain in the mandibular first molar teeth were selected. Patients were randomized into one of the following groups: Group I-Conventional lidocaine (Control), Group II-Buffered lidocaine (Experimental), and Group III-Precooled lidocaine with intraoral cryotherapy (Experimental). All patients received an IANB followed by which the pain at the site, onset of action, duration, anesthetic efficacy, and success rate were compared and evaluated. Statistical Analysis: Kruskal-Wallis and Chi-square tests were used for statistical analysis. Results: Data were statistically analyzed and there was a significant reduction in pain at the site with faster onset of action and higher anesthetic efficacy in buffered lidocaine followed by precooled lidocaine. The success rate for conventional IANB is 38.9%, for buffered lidocaine, 86.2%, and for precooled lidocaine, 78.9%. Conclusions: In patients with a mandibular molar presenting with SIP, block anesthesia with buffered lidocaine showed the best results and a superior success rate, followed by precooled lidocaine, with the least efficacy seen in the conventional lidocaine group. Keywords: Anesthetic efficacy, cryotherapy, inferior alveolar nerve block, precooled lidocaine, symptomatic irreversible pulpitis