Restor Dent Endod.  2021 Feb;46(1):e9. 10.5395/rde.2021.46.e9.

Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial

• Paul S
• Nandamuri S
• Raina A
• Bansal M

• KMID: 2548059
• DOI: http://doi.org/10.5395/rde.2021.46.e9

Abstract

Objectives
This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS).
Materials and Methods
This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HPVAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests.
Results
The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP.
Conclusions
Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

Keyword

Anesthesia; Buccal infiltration; Inferior alveolar nerve block; Irreversible pulpitis; Lignocaine; Piroxicam

Figure

• 

  Figure 1 Comparison of mean pain scores during various procedures between the 2 groups. Error bars represent standard deviations.IPS, initial pain score; CR, caries removal; AOP, access opening procedure; WLM, working length measurement.

Reference

1. Handysides RA, Jaramillo DE, Ingle JI. Examination, evaluation, diagnosis and treatment planning. In : Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle's endodontics. 6th ed. Hamilton, ON: BC Decker Inc.;2008. p. Chapter 14.

2. Ali SG, Mulay S. Pulpitis: a review. IOSR J Dent Med Sci. 2015; 14:92–97.

3. Aggarwal V, Singla M, Kabi D. Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod. 2010; 36:375–378. PMID: 20171350.

4. Akhlaghi NM, Hormozi B, Abbott PV, Khalilak Z. Efficacy of ketorolac buccal infiltrations and inferior alveolar nerve blocks in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod. 2016; 42:691–695. PMID: 26964901.

5. Rogers BS, Botero TM, McDonald NJ, Gardner RJ, Peters MC. Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod. 2014; 40:753–758. PMID: 24862701.

6. Prasanna N, Subbarao CV, Gutmann JL. The efficacy of pre-operative oral medication of lornoxicam and diclofenac potassium on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a double-blind, randomised controlled clinical trial. Int Endod J. 2011; 44:330–336. PMID: 21692235.

7. Verma PK, Srivastava R, Ramesh KM. Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: a clinical study. J Conserv Dent. 2013; 16:162–166. PMID: 23716971.

8. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics: mechanisms and management. Endod Topics. 2002; 1:26–39.

9. Smith WL, DeWitt DL, Garavito RM. Cyclooxygenases: structural, cellular, and molecular biology. Annu Rev Biochem. 2000; 69:145–182. PMID: 10966456.

10. Aggarwal V, Singla M, Rizvi A, Miglani S. Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis. J Endod. 2011; 37:445–449. PMID: 21419287.

11. Brogden RN, Heel RC, Speight TM, Avery GS. Piroxicam: a review of its pharmacological properties and therapeutic efficacy. Drugs. 1981; 22:165–187. PMID: 7021122.

12. Shanbagh TV, Shenoy S, Nayak V. Autacoids and respiratory system. In : Shanbagh TV, Shenoy S, Nayak V, editors. Pharmacology for dental students. 2nd ed. Taramani, Chennai: Elsevier;2010. p. Chapter 7.

13. Wiseman RL, Kilgour M. Intramuscular piroxicam, a new dosage form, in the treatment of acute musculoskeletal disorders. J Int Med Res. 1985; 13:255–262. PMID: 2932357.

14. Cohen HP, Cha BY, Spångberg LS. Endodontic anesthesia in mandibular molars: a clinical study. J Endod. 1993; 19:370–373. PMID: 8245762.

15. Parirokh M, Satvati SA, Sharifi R, Rekabi AR, Gorjestani H, Nakhaee N, Abbott PV. Efficacy of combining a buccal infiltration with an inferior alveolar nerve block for mandibular molars with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109:468–473. PMID: 20219602.

16. Parirokh M, Yosefi MH, Nakhaee N, Abbott PV, Manochehrifar H. The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain. Restor Dent Endod. 2015; 40:155–160. PMID: 25984478.

17. Kaviani N, Khademi A, Ebtehaj I, Mohammadi Z. The effect of orally administered ketamine on requirement for anesthetics and postoperative pain in mandibular molar teeth with irreversible pulpitis. J Oral Sci. 2011; 53:461–465. PMID: 22167031.

18. Vadivelu N, Gowda AM, Urman RD, Jolly S, Kodumudi V, Maria M, Taylor R Jr, Pergolizzi JV Jr. Ketorolac tromethamine - routes and clinical implications. Pain Pract. 2015; 15:175–193. PMID: 24738596.

19. Joshi N, Mathew S, George JV, Hegde S, Bhandi S, Madhu KS. Comparative evaluation of the efficacy of two modes of delivery of Piroxicam (Dolonex^®) for the management of postendodontic pain: a randomized control trial. J Conserv Dent. 2016; 19:301–305. PMID: 27563175.

20. Atbaei A, Mortazavi N. Prophylactic intraligamentary injection of piroxicam (feldene) for the management of post-endodontic pain in molar teeth with irreversible pulpitis. Aust Endod J. 2012; 38:31–35. PMID: 22432824.

21. Subhan Z, Shami S, Ahmed Rana MJ. Comparison of prophylactic intraligamentary injection of piroxicam and lignocaine for management of postoperative endodontic pain. Pak Oral Dent J. 2016; 36:480–483.

22. Yadav S. Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: a systematic review. J Conserv Dent. 2015; 18:182–186. PMID: 26069400.

23. Goddard G, Karibe H, McNeill C. Reproducibility of visual analog scale (VAS) pain scores to mechanical pressure. Cranio. 2004; 22:250–256. PMID: 15293781.

24. Averbuch M, Katzper M. Assessment of visual analog versus categorical scale for measurement of osteoarthritis pain. J Clin Pharmacol. 2004; 44:368–372. PMID: 15051743.

25. Jena A, Shashirekha G. Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: a placebo-controlled clinical study. J Conserv Dent. 2013; 16:171–174. PMID: 23716973.