Evaluating the effect of oral premedication with nonsteroidal anti-inflammatory drugs on the anesthetic success of inferior alveolar nerve block in treatment of irreversible pulpitis
Keywords:
Etorocoxib, Inferior alveolar nerve block, Irreversible pulpitis, Ketorolac, NSAIDs, PiroxicamAbstract
INTRODUCTIONAchieving profound anesthesia in mandibular molars with symptomatic irreversible pulpitis is often difficult, with high failure rates reported for inferior alveolar nerve block (IANB). Preoperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) may improve anesthetic efficacy by reducing inflammation and nociceptor sensitization. Objective of the study is to compare the effect of oral premedication with ketorolac, piroxicam, and etorocoxib on the anesthetic success of IANB in patients with symptomatic irreversible pulpitis.
MATERIAL AND METHODSThis cross-sectional, observational study included 120 patients aged 18–60 years with symptomatic irreversible pulpitis in mandibular molars. Participants were randomly allocated into four groups (n=30 each): etorocoxib (90 mg), ketorolac (10 mg), piroxicam (20 mg) and placebo. Premedication was administered 45 minutes prior to IANB using 2% lidocaine with 1:200,000 epinephrine. Pain was assessed using the Visual Analog Scale (VAS) before medication, after 45 minutes, and during access opening and instrumentation. Anesthetic success was defined as absence of pain during the procedure. Data were analyzed using ANOVA and post hoc Tukey tests.
RESULTSNSAID premedication significantly reduced VAS scores compared to placebo (p<0.001). Piroxicam showed the greatest reduction in intraoperative pain, followed by etorocoxib and ketorolac. Post hoc analysis demonstrated significant differences between placebo and all NSAID groups, while no significant difference was observed between piroxicam and etorocoxib during instrumentation.
CONCLUSIONOral premedication with NSAIDs significantly improves the success of IANB in symptomatic irreversible pulpitis, with piroxicam showing the most favorable outcome.
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