Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study

J Endod. 2015 Jan;41(1):33-5. doi: 10.1016/j.joen.2014.09.011. Epub 2014 Oct 31.


Introduction: The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of buffered with nonbuffered 2% lidocaine with 1:80,000 epinephrine solution for inferior alveolar nerve (IAN) block in patients with mandibular posterior teeth experiencing symptomatic irreversible pulpitis.

Methods: Eighty adult patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received 2 cartridges of either 2% lidocaine with 1:80,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:80,000 epinephrine with 0.18 mL sterile distilled water using conventional IAN block injections. Endodontic access preparation was initiated 15 minutes after injection. Lip numbness was required for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by the t, Mann-Whitney, and chi-square tests.

Results: The success rates were 62.5% and 47.5% for buffered and nonbuffered groups, respectively, with no significant differences between the two groups (P = .381).

Conclusions: Buffering the 2% lidocaine with 1:80,000 epinephrine with 8.4% sodium bicarbonate did not improve the success of the IAN block in mandibular molars in patients with symptomatic irreversible pulpitis.

Keywords: Buffered; inferior alveolar nerve block; irreversible pulpitis; local anesthesia; sodium bicarbonate.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Anesthesia / administration & dosage
  • Adult
  • Anesthesia, Dental / methods
  • Anesthesia, Local / methods
  • Anesthetics, Combined / administration & dosage
  • Anesthetics, Local / administration & dosage
  • Buffers
  • Double-Blind Method
  • Epinephrine / administration & dosage
  • Female
  • Humans
  • Lidocaine / administration & dosage*
  • Lip / innervation
  • Male
  • Mandibular Nerve / drug effects*
  • Middle Aged
  • Molar
  • Nerve Block / methods*
  • Pain / drug therapy
  • Prospective Studies
  • Pulpitis / drug therapy
  • Pulpitis / physiopathology*
  • Root Canal Preparation / methods
  • Sodium Bicarbonate / administration & dosage*
  • Young Adult


  • Adjuvants, Anesthesia
  • Anesthetics, Combined
  • Anesthetics, Local
  • Buffers
  • Sodium Bicarbonate
  • Lidocaine
  • Epinephrine