Comparing the anaesthetic efficacy of 1.8 mL and 3.6 mL of anaesthetic solution for inferior alveolar nerve blocks for teeth with irreversible pulpitis: a systematic review and meta-analysis with trial sequential analysis.

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Abstrakt

Tytuł:: Comparing the anaesthetic efficacy of 1.8 mL and 3.6 mL of anaesthetic solution for inferior alveolar nerve blocks for teeth with irreversible pulpitis: a systematic review and meta-analysis with trial sequential analysis.
Autorzy:: Nagendrababu V; Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.; Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE.
Abbott PV; UWA Dental School, University of Western Australia, Nedlands, Australia.
Pulikkotil SJ; Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
Veettil SK; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA.
Dummer PMH; School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Źródło:: International endodontic journal [Int Endod J] 2021 Mar; Vol. 54 (3), pp. 331-342. Date of Electronic Publication: 2020 Nov 10.
Typ publikacji:: Journal Article; Meta-Analysis; Review; Systematic Review
Język:: English
Imprint Name(s):: Original Publication: Oxford, Blackwell Scientific Publications.
MeSH Terms:: Anesthesia, Dental*
Nerve Block*
Pulpitis*/surgery
Adolescent ; Adult ; Aged ; Anesthetics, Local ; Double-Blind Method ; Humans ; Lidocaine ; Mandibular Nerve ; Middle Aged ; Young Adult
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Contributed Indexing:: Keywords: inferior alveolar nerve block; irreversible pulpitis; local anaesthesia; randomized clinical trial; systematic review
Substance Nomenclature:: 0 (Anesthetics, Local)
98PI200987 (Lidocaine)
Entry Date(s):: Date Created: 20201011 Date Completed: 20210215 Latest Revision: 20210215
Update Code:: 20240105
DOI:: 10.1111/iej.13428
PMID:: 33040335
: Czasopismo naukowe

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Background: The scientific literature is contradictory in relation to selecting the appropriate volume of local anaesthetic solution for inferior alveolar nerve blocks (IANB) when attempting to anaesthetize mandibular teeth with irreversible pulpitis.
Objectives: To compare the efficacy of 1.8 and 3.6 mL of the same anaesthetic solution for IANBs when treating mandibular teeth with irreversible pulpitis.
Methods: A literature search was performed in PubMed, Scopus and EBSCOhost databases until May 2020. Randomized clinical trials published in English, comparing 1.8 with 3.6 mL of the same anaesthetic solution for IANBs in permanent mandibular teeth with irreversible pulpitis, were included. The risk of bias of the included trials was appraised using the revised Cochrane risk of bias tool. A meta-analysis was performed using the random-effects model. The effect of random errors on the results of the meta-analysis was evaluated by trial sequential analysis and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
Results: Four clinical trials involving 280 teeth from patients with ages ranging from 18 to 65 years were included. Among the four trials, three were categorized as having a 'low' risk of bias and one was categorized as having 'some concerns'. The primary meta-analysis revealed that 3.6 mL of anaesthetic solution when administered for IANBs was associated with significantly greater success rates compared with 1.8 mL (RR = 1.94; 95% CI, 1.07, 3.52; I 2 = 77%). Similarly, the results of the sensitivity analysis (restricting trials only to those that used the Heft-Parker visual analogue pain scale) revealed that the use of 3.6 mL significantly increased the success of IANBs compared with 1.8 mL. The trial sequential analysis confirmed the evidence for the beneficial effect of 3.6 mL to achieve success for IANBs was 'conclusive'. The quality of evidence was graded as 'high'.
Conclusion: Increasing the volume of anaesthetic solution from 1.8 to 3.6 mL improved the success rate for IANBs in mandibular molars with irreversible pulpitis. The quality of the evidence was 'high'. Future high-quality clinical trials are required with different types of anaesthetic solutions and other types of teeth.
(© 2020 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

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