Comparative Evaluation of Anesthetic Efficacy of Warm and Conventional 2% Lignocaine for the Success of Inferior Alveolar Nerve Block (IANB) in Mandibular Permanent Molars: A Randomized Controlled Clinical Trial

Maha Ali Mirza; Syed Muzammil Hussain; Ajmal Yousaf; Areeba Maryam; Qurat-ul-ain Abbasi; Kanza Zafar

doi:10.51253/pafmj.v76iSUPPL-6.13573

Authors

Maha Ali Mirza Department of Dentistry, Armed Forces Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Syed Muzammil Hussain Department of Dentistry, Armed Forces Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Ajmal Yousaf Department of Dentistry, Armed Forces Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Areeba Maryam Department of Dentistry, Armed Forces Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Qurat-ul-ain Abbasi Department of Dentistry, Armed Forces Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Kanza Zafar Department of Dentistry, Armed Forces Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-6.13573

Keywords:

Endodontics, Inferior alveolar nerve block, Lignocaine, Local anesthesia, Pain Reduction, Visual analogue scale, Warming

Abstract

Objective: To evaluate and compare the anesthetic effectiveness of warm versus conventional 2% Lignocaine in achieving successful inferior alveolar nerve block (IANB) for mandibular permanent molars.

Study Design: Randomized Controlled Trial (ClinicalTrials.gov: NCT06806202)

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, Pakistan from Dec 2024 to Mar 2025.

Methodology: A double-blind clinical trial involving 70 patients (35 in each Group) diagnosed with irreversible pulpitis was conducted to compare the efficacy of 2% Lignocaine administered at 25°C (Group A) and 42°C (Group B) for inferior alveolar nerve block (IANB). Pain during injection was evaluated using the Visual Analogue Scale (VAS), and the onset of anesthesia in seconds was determined with an electric pulp tester.

Results: There was a significant difference in pain during administration of anesthesia between Group A (25°C) with median VAS score of 7.00 (IQR: 2.00) and of Group B (42°C) with median VAS score of 2.00 (IQR: 2.00) on Visual Analogue Scale (VAS) with a p-value < 0.001. Similarly, the onset time of anesthesia in seconds was significantly shorter in Group B (42°C) with a median of 208.2 seconds (IQR: 11.34) as compared to the Group A (25°C) with a median onset time of 286.8 seconds (IQR: 9.9) with the p-value < 0.001. ....

Conclusion: Within limitation of the study it is concluded that warmed Lignocaine is more effective than Lignocaine at room temperature in reducing pain during administration and achieving faster onset of anesthesia in seconds.

Downloads

Download data is not yet available.

References

1. Santini M, Da Rosa RA, Ferreira MB, Barletta F, Do Nascimento AL, Weissheimer T, Estrela C, So MV. Medications used for prevention and treatment of postoperative endodontic pain: a systematic review. Eur Endod J 2021; 6(1): 15 http://doi.org/10.14744/eej.2020.85856

2. Bartholomew O, Hogden C, Randall CL, Qian F, Bowers R. Challenges in achieving profound local anesthesia: Insights from a patient survey. JADA Journal of the American Dental Association 2025; 156(7): 530-537.

https://doi.org/10.1016/j.adaj.2025.03.015

3. Herrera JE, Quino CF, Cerrate VC, Rodríguez YC. Effect of the temperature of lidocaine 2% with epinephrine 1: 80,000 on pain from injection and onset of action in blocking the inferior alveolar nerve. Revi de Admin 2015; 72(5): 236-242.

4. Kupietzky A, Schwartz S. Local Anesthesia. Wright's behavior management in dentistry for children. First Edition, John Wiley & Sons, Inc. 2021. https://doi.org/10.1002/9781119680987.ch9

5. Karunakar P, Solomon RV, Kumar BS, Reddy SS. 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. J Conserv Dent Endod 2024; 27(12): 1228-1233. https://doi.org/10.4103/jcde.jcde_625_24

6. Tirupathi SP, Nanda N, Pallepagu S, Malothu S, Rathi N, Chauhan RS, et al. The combined effect of extraoral vibratory stimulus and external cooling on pain perception during intra-oral local anesthesia administration in children: a systematic review and meta-analysis. J Dent Anesth Pain Med 2022; 22(2): 87.

https://doi.org/10.17245/jdapm.2022.22.2.87

7. Ing EB, Philteos J, Sholohov G, Kim DT, Nijhawan N, Mark PW, et al. Local anesthesia and anxiolytic techniques for oculoplastic surgery. Clin Ophthalmol 2019; 13(1): 153.

https://doi.org/10.2147/OPTH.S188790

8. Aravena PC, Barrientos C, Troncoso C, Coronado C, Sotelo-Hitschfeld P. Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial. Local Reg Anesth 2018; 9-13.

https://doi.org/10.2147/lra.s147288

9. Afsal MM, Khatri A, Kalra N, Tyagi R, Khandelwal D. Pain perception and efficacy of local analgesia using 2% Lignocaine, buffered Lignocaine, and 4% articaine in pediatric dental procedures.J Dent Anesth Pain Med 2019; 19(2): 101-109.

https://doi.org/10.17245/jdapm.2019.19.2.101

10. Gandhi N, Shah N, Wahjuningrum DA, Purnomo S, Nooshian R, Arora S, et al. Evaluation of pulpal anesthesia and injection pain using IANB with pre-heated, buffered and conventional 2% Lignocaine in teeth with symptomatic irreversible pulpitis—a randomized clinical study. PeerJ. 2022; 10: e14187.

https://doi.org/10.7717/peerj.14187

11. Saeed SA, Mahmood S, Baig NJ, Khan NA, Rasheed N, Kakar NA. Effect of Warming Anesthetic Solution on Pain Perception During Maxillary Infiltration: A Split Mouth Randomized Control Trial. Pak Armed Forces Med J 2022; 72(1): 240.

https://doi.org/10.51253/pafmj.v72i1.6860

12. Chittora M, Rao D, Panwar S, Samaddar K, Remi RV. A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7–9-year-old children: A randomized split-mouth cross-over trial. J Indian Soc Pedod Prev Dent 2024; 42(2): 126-133.

https://doi.org/10.4103/jisppd.jisppd_52_24

13. Ibrahim A, Habashy L, Hafez SM, Sharaf D. Effect of Pre-Warming Of Local Anesthesia on Reducing Pain Perception during Injection in Children: A Randomized Controlled Clinical TRIAL. Alex Dent J. 2025

https://dx.doi.org/10.21608/adjalexu.2025.349737.1579

14. Tirupathi SP, Rajasekhar S. Effect of warming local anesthesia solutions before intraoral administration in dentistry: a systematic review. J Dent Anesth Pain Med 2020; 20(4): 187-194.

https://doi.org/10.17245/jdapm.2020.20.4.187

15. Kurien RS, Goswami M. Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% Lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: A randomized controlled clinical trial.

J Dent Res Dent Clin Dent Prospects 2018; 12(2): 102.

https://doi.org/10.15171/joddd.2018.016

16. Nagendrababu V, Duncan HF, Whitworth J, Nekoofar MH, Pulikkotil SJ, Veettil SK, et al. Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrellareview. Int Endod J 2020; 53(2): 200-213

https://doi.org/10.1111/iej.13215

17. Fu-Chao Liu, Jiin-TarngLiou, Yuan-Ji Day, Allen H. Li, Huang-Ping Yu. Effect of warm lidocaine on the sensory onset of epidural anesthesia: a randomized trial. Chang Gung Med J 2009; 32: 643-649.

18. Allen MJ, Bunce C, Presland AH. The effect of warming local anaesthetic on the pain of injection during sub‐Tenon's anaesthesia for cataract surgery. Anaesthesia 2008 ; 63(3): 276-278

https://doi.org/10.1111/j.1365-2044.2007.05351.x