Buffered 1% Lidocaine With Epinephrine Is as Effective as Non-Buffered 2% Lidocaine With Epinephrine for Mandibular Nerve Block

Victor T. Warren, Anson G. Fisher, Eric M. Rivera, Pooja T. Saha, Blake Turner, Glenn Reside, Ceib Phillips, Raymond P. White

Research output: Contribution to journalArticle

  • 1 Citations

Abstract

Purpose To assess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2% lidocaine with 1:100,000 EPI. Patients and Methods In a randomized cross-over trial approved by the institutional review board, buffered 1% lidocaine with 1:100,000 EPI was compared with non-buffered 2% lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than.05. Results Fifty-seven percent of patients were women and 43% were men. Seventy percent were Caucasian, 17% were African American, and 13% had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P <.01). Conclusions After mandibular nerve block, buffered 1% lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2% lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.

LanguageEnglish (US)
Pages1363-1366
Number of pages4
JournalJournal of Oral and Maxillofacial Surgery
Volume75
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Mandibular Nerve
Nerve Block
Lidocaine
Epinephrine
Pain
Canidae
Drug Compounding
Injections
Nonparametric Statistics
Anesthesia
Research Ethics Committees
Drug Combinations
African Americans
Cross-Over Studies
Tooth
Body Weight

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology

Cite this

Buffered 1% Lidocaine With Epinephrine Is as Effective as Non-Buffered 2% Lidocaine With Epinephrine for Mandibular Nerve Block. / Warren, Victor T.; Fisher, Anson G.; Rivera, Eric M.; Saha, Pooja T.; Turner, Blake; Reside, Glenn; Phillips, Ceib; White, Raymond P.

In: Journal of Oral and Maxillofacial Surgery, Vol. 75, No. 7, 01.07.2017, p. 1363-1366.

Research output: Contribution to journalArticle

@article{a400ef38fed342a3a86d1bd20827a509,
title = "Buffered 1{\%} Lidocaine With Epinephrine Is as Effective as Non-Buffered 2{\%} Lidocaine With Epinephrine for Mandibular Nerve Block",
abstract = "Purpose To assess outcomes for pulpal anesthesia and pain on injection for buffered 1{\%} lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2{\%} lidocaine with 1:100,000 EPI. Patients and Methods In a randomized cross-over trial approved by the institutional review board, buffered 1{\%} lidocaine with 1:100,000 EPI was compared with non-buffered 2{\%} lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than.05. Results Fifty-seven percent of patients were women and 43{\%} were men. Seventy percent were Caucasian, 17{\%} were African American, and 13{\%} had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P <.01). Conclusions After mandibular nerve block, buffered 1{\%} lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2{\%} lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.",
author = "Warren, {Victor T.} and Fisher, {Anson G.} and Rivera, {Eric M.} and Saha, {Pooja T.} and Blake Turner and Glenn Reside and Ceib Phillips and White, {Raymond P.}",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.joms.2016.12.045",
language = "English (US)",
volume = "75",
pages = "1363--1366",
journal = "Journal of Oral and Maxillofacial Surgery",
issn = "0278-2391",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Buffered 1% Lidocaine With Epinephrine Is as Effective as Non-Buffered 2% Lidocaine With Epinephrine for Mandibular Nerve Block

AU - Warren,Victor T.

AU - Fisher,Anson G.

AU - Rivera,Eric M.

AU - Saha,Pooja T.

AU - Turner,Blake

AU - Reside,Glenn

AU - Phillips,Ceib

AU - White,Raymond P.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Purpose To assess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2% lidocaine with 1:100,000 EPI. Patients and Methods In a randomized cross-over trial approved by the institutional review board, buffered 1% lidocaine with 1:100,000 EPI was compared with non-buffered 2% lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than.05. Results Fifty-seven percent of patients were women and 43% were men. Seventy percent were Caucasian, 17% were African American, and 13% had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P <.01). Conclusions After mandibular nerve block, buffered 1% lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2% lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.

AB - Purpose To assess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2% lidocaine with 1:100,000 EPI. Patients and Methods In a randomized cross-over trial approved by the institutional review board, buffered 1% lidocaine with 1:100,000 EPI was compared with non-buffered 2% lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than.05. Results Fifty-seven percent of patients were women and 43% were men. Seventy percent were Caucasian, 17% were African American, and 13% had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P <.01). Conclusions After mandibular nerve block, buffered 1% lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2% lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.

UR - http://www.scopus.com/inward/record.url?scp=85014571448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014571448&partnerID=8YFLogxK

U2 - 10.1016/j.joms.2016.12.045

DO - 10.1016/j.joms.2016.12.045

M3 - Article

VL - 75

SP - 1363

EP - 1366

JO - Journal of Oral and Maxillofacial Surgery

T2 - Journal of Oral and Maxillofacial Surgery

JF - Journal of Oral and Maxillofacial Surgery

SN - 0278-2391

IS - 7

ER -