Evaluation of three different drugs administered through intraligamentary route for reduction of intraoperative pain of symptomatic irreversible pulpitis in mandibular molars - A randomized triple-blind single-center clinical study

Abstract

Introduction: Managing intraoperative pain while initiating root canal treatment necessitates the use of supplementary injection techniques. Aim: The study sought to assess and compare the anesthetic efficacy of 0.5% bupivacaine and 50 mg/ml tramadol hydrochloride versus 2% lignocaine administered as supplemental intraligamentary injection as an adjuvant to an inferior alveolar nerve block (IANB) for mandibular molars with symptomatic irreversible pulpitis (SIP) and normal apical tissues during access cavity preparation. Materials and Methods: Two hundred and two individuals with mandibular molars diagnosed with SIP with normal apical tissues and exhibiting moderate-to-intense pain were given 2 ml of IANB containing 2% lignocaine and 1:80,000 epinephrine. The Visual Analog Scale (VAS) was used to record intraoperative discomfort. Individuals who scored more than 5 on the VAS were deemed to need further anesthesia. The intraligamentary medication was given to 99 of these patients after they were randomly assigned to 3 groups (2% lignocaine, 0.5% bupivacaine, and 50 mg/ml tramadol). VAS score was again recorded. If the patient reported no pain during the opening of the access, it was deemed a success. The post hoc Tukey's test, paired t-test, and one-way analysis of variance were the statistical methods used to examine the data. Results: Maximum reduction in pain was in bupivacaine followed by lignocaine and tramadol (P < 0.05). Subgroup analysis using post hoc Tukey's honestly significant difference test showed a maximum difference between bupivacaine and tramadol (1.273, P > 0.05) (95% confidence interval [CI]), followed by lignocaine and bupivacaine (-1.182, P < 0.05) (95% CI) and lignocaine and tramadol (0.091, P > 0.05) (95% CI). Conclusion: Bupivacaine was most effective in reduction of intraoperative pain when used as an intraligamentary drug during access cavity preparation followed by lignocaine. Tramadol was the least successful drug for achieving effective pulpal anesthesia.