Comparison of Preoperative Oral Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block and Buccal and Lingual Infiltration with Articaine and Lidocaine in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind

IntroductionIrreversible pulpitis (IP) commonly results in decreased anesthetic efficacy of the inferior alveolar nerve block (IANB) for mandibular molar. It has been shown that supplementary buccal and/or lingual infiltration as well as premedication with ketorolac result in improved efficacy of the IANB.MethodsOne hundred fifty emergency patients who had their lower first or/and second molar diagnosed with IP participated in the study. All patients were randomly divided into 2 major IANB groups: 1 group received 4% articaine with 1:100,000 epinephrine, and the other group received 2% lidocaine with 1:80,000 epinephrine. Each group was further divided into 3 subgroups of 25 each: (1) buccal and lingual infiltration with articaine and lidocaine, respectively; (2) preoperative oral medication of ketorolac; and (3) preoperative oral medication of ketorolac followed by buccal and lingual infiltration with articaine and lidocaine, respectively. Endodontic access was initiated 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success of the anesthetic was defined as none or mild pain on endodontic access and initial instrumentation.ResultsStatistical analysis was performed using multiple-comparison analysis of variance (Kruskal-Wallis) and t tests. Articaine IANB with infiltrations plus oral ketorolac premedication significantly increased the success rate to 76%. The success rate after the administration of an articaine IANB with infiltration injections was 64%, whereas with lidocaine it was 32% (P < .05).ConclusionsPremedication with ketorolac significantly increases the anesthetic efficacy of articaine IANB plus infiltration in mandibular molars with IP.