Alveolar Nerve Block In Patients Research Articles

Can postanesthetic cold sensibility test be used as a tool for the efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis of mandibular molars? – In vivo study

Objectives: The goal of this investigation was to determine the efficiency of a postanesthetic cold test for the detection of pulpal anesthesia to improve diagnostic accuracy. Materials and Methods: Fifty-two participants who showed symptomatic irreversible pulpitis on the mandibular first molar, aged from 18 to 65 years, were given inferior alveolar nerve block (IANB), and subjective anesthetic symptoms were seen after 15 min and were finally assigned for studies. To determine the effectiveness of a postanesthetic cold test for the detection of pulpal anesthesia, the target tooth was separated and Endo-Frost was utilized to conduct a postanesthetic cold sensibility test and was compared to the gold standard test, painful or painless sensation during actual root canal therapy. Of 52 participants, 9 had a positive response to the postanesthetic cold test and 43 had a negative response; 10 responded positively to the gold standard test, whereas 42 gave negative results. Results: The postanesthetic cold sensibility test can diagnose the effectiveness of pulp anesthesia showing a sensitivity of 80%, specificity of 97.62%, positive likelihood ratio of 33.6, negative likelihood ratio of 0.2, positive predictive value of 88.89%, negative predictive value of 95.35%, accuracy of 94.23%, and Youden’s index of 0.78. Conclusions: The postanesthetic cold sensibility test can be used as a tool for the efficiency of IANB before starting root canal therapy to minimize pain and anxiety in patients.

Effectiveness of Lidocaine versus Lidocaine with Magnesium Sulphate During Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Randomised Double-Blinded Clinical Trial.

This study aimed to compare the effectiveness of lidocaine with magnesium sulphate in patients undergoing root canal treatment following irreversible pulpitis. A total of 86 patients were randomised to receive 1.8 ml of 2% lidocaine replaced with 0.2 ml of 10% magnesium sulphate with 1: 80,000 epinephrine (n=43) as MGS group and 1.8 ml of 2% lidocaine with 1: 80,000 epinephrine (n=43) as LDC group. Preoperative visual analogue scale (VAS) pain scores were record-ed. Patients were instructed to report any perioperative pain felt during the access cavity preparation and when introducing the first patency file (#10 k) in the root canal and perioperative VAS recorded. The success rate of the inferior alveolar nerve block (IANB) was higher in the MSG group. The mean+-SD of perioperative pain was 0.16+-0.37 in the MSG group and 3.13+-0.77 in the LDC group. The MGS group produced better anaesthetic efficacy with a p-value of 0.01. Based on the results, adding 10% magnesium sulphate to 2% lidocaine increased the effective-ness of IANB in patients with symptomatic irreversible pulpitis of mandibular molar teeth.

Effect of preoperative analgesics and cooled Lidocaine with Epinephrine on the anesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A single-blind, randomized controlled trial

Background:Treating mandibular molars with symptomatic irreversible pulpitis poses challenges, as achieving anaesthesia in “hot teeth” is difficult. Epinephrine aids anaesthesia by reducing blood absorption through local vasoconstriction. However, when epinephrine is contraindicated, cooling the anaesthetic may provide effective vasoconstriction in cutaneous arteries and inhibit sensory nerve action potentials, enhancing anaesthetic efficacy.Aim:To evaluate the effectiveness of preoperative analgesics and cooling of 2% lidocaine solution with 1:200,000 Epinephrine on the efficacy of Inferior alveolar nerve block (IANB) during root canal treatment in patients with symptomatic irreversible pulpitis of the mandibular molars.Materials and methods:This study was conducted on 36 subjects diagnosed with symptomatic irreversible pulpitis. Participants were randomly assigned into one of three groups, each consisting of 12 patients (n=12). The subjects in Group A (Control) received Vitamin E 400 mg tablets as premedication and Local Anaesthetic injection of 2% Lignocaine at room temperature. The subjects in Group B received Piroxicam 20 mg tablets as premedication and local anaesthetic injection of 2% Lignocaine at Room Temperature. The subjects in Group C received Piroxicam 20 mg tablets as premedication and local anaesthetic injection of 2% Lignocaine at 4° Celsius. The patient’s preoperative pain levels before and after administering the analgesic, before and after the administration of local anaesthesia and intraoperative pain levels were recorded using the Heft-Parker visual analogue scale. Anaesthetic success was again evaluated after re-initiation of the endodontic treatment. The heart rates of the patients were measured using a finger pulse oximeter.Results:The patients in group C showed the highest mean difference in pain levels followed by group B and A. However, the Group A patients displayed the highest heart rates followed by Groups B and C. One-way ANOVA showed a significant differences in the pain levels (p=0.0002) and heart rates (p=0.0004) among the groups.Conclusion:This study showed that Piroxicam effectively achieved IANB in patients with symptomatic irreversible pulpitis of mandibular molars. Cooling 2% lidocaine with 1:200,000 epinephrine to 4°C significantly reduced post-injection heart rate and enhanced anesthetic success.

Comparison of The Effectiveness Between Preoperative Ibuprofen Verses Placebo On the Success of the Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

The inferior alveolar nerve block is the simplest often utilized injection procedure in dentistry, and numerous variations of the traditional nerve block have lately been reported. The dentist or surgeon must consider a variety of aspects before choosing the optimum approach, considering the treatment's effectiveness probability and potential problems. Objective: To compare the effectiveness of preoperative ibuprofen verses placebo in enhancing the success of inferior alveolar nerve block in patients with irreversibly inflamed pulp. Methods: This randomized control trial was performed for a period of 6 months. Data collection was done after taking approval from hospital ethical committee of Altamash Institute of Dental Medicine. 236 patients were included in this study. The participant was told to assess their level of discomfort after the endodontic treatment. Results: From 236 patients, the minimum age was found 18 years and maximum age was 45 years. Males were 123/236 (52.1%) while females were 113/236 (47.9%). Effectiveness of both materials was found in 74/236 (31.4%) patients. Effectiveness of materials was found significant in both groups (Ibuprofen, Placebo) having p-value 0.012. Conclusions: The effectiveness of materials was significant in both groups (Ibuprofen, Placebo). Effect modifier like age, duration of pain and gender has no significant association with effectiveness of materials.

Effect of premedication on the success of inferior alveolar nerve block in patients diagnosed with irreversible pulpitis: An umbrella review

Successful management of pain during endodontic treatment is essential for both patients and dentists. Achieving adequate pulp anesthesia in mandibular molars is a significant concern for patients with irreversible pulpitis during endodontic treatment. The increased sensitization of nociceptors due to inflammation decreases the success of inferior alveolar nerve block (IANB). The main focus is on reducing inflammation before delivery of local anesthesia to increase the success of anesthetic drugs. This umbrella review aimed to revise, qualify and summarize the existing body of evidence on the effect of premedication on IANB in patients with irreversible pulpitis. A literature search was conducted using electronic databases (PubMed, Scopus, the Web of Science, and the Cochrane Library) with no date restriction until September 2021 to identify the relevant studies. All the cross-references of the selected studies and grey literature were also screened. Four systematic reviews assessing the effect of premedication on the success of IANB were selected. A conclusion was drawn that premedication with >400 mg of ibuprofen can positively affect the success of IANB.

The Effect of Preoperative Naproxen Sodium on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

The Effect of Preoperative Naproxen Sodium on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.

The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.

Efficacy of adding dexmedetomidine to lidocaine to enhance inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis: double-blind randomized clinical trial.

This randomized, double-blind study was to determine whether dexmedetomidine (DEX) helped to improve the inferior alveolar nerve block's (IANB) success in patients with asymptomatic irreversible pulpitis (AIP). We hypothesized that adding DEX to lidocaine enhances the anesthetic effect of lidocaine to a satisfactory level by localizing anesthesia in a safer way. Fifty adult volunteers with AIP in a first or second mandibular molar were randomly assigned to two groups to either receive 1.4ml 2% plain lidocaine or 1.4ml 2% lidocaine + 0.4ml (40μg) DEX, for standard IANB injection. Access cavity preparation initiated 10-15min postinjection when the patient reported lower lip numbness and had two negative electric pulp tests (EPTs) with 5-min intervals. Heft-Parker visual analog scale (VAS) was used to report pain in three steps: during caries and dentin removal, access cavity preparation, and canal working-length determinations; EPT and VAS were analyzed by Friedman test; and success rates were analyzed by Mann-Whitney and Fisher's exact test using SPSS software version 20. Successful anesthesia (defined as no or mild pain during any of steps and no need for additional injection) is obtained in 12% of patients in the lidocaine group, while DEX-lidocaine group increased the success rate of IANB to 72% (p-value = 0.0001). DEX significantly increases the anesthetic effect of lidocaine in IANB injection in patients with AIP. DEX would be a safe adjunct to lidocaine to increase the success rate in IANB and could be a suitable alternative for conventional vasoconstrictors in sensitive groups.

Preoperative oral medication of combination of Ibuprofen and Dexamethasone can improve the anesthetic success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis

Preoperative oral medication of combination of Ibuprofen and Dexamethasone can improve the anesthetic success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis

Effect of a Combination of Nitrous Oxide and Intraligamentary Injection on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

IntroductionThe purpose of this prospective study was to determine the effect of a combination of nitrous oxide/oxygen and 1 set of supplemental intraligamentary/periodontal ligament (PDL) injections followed by a second set of PDL injections on anesthetic success in patients with symptomatic irreversible pulpitis (SIP). MethodsNinety-four patients with a mandibular posterior tooth diagnosed with SIP received nitrous oxide/oxygen and an inferior alveolar nerve block (IANB) with 2% lidocaine with 1:100,000 epinephrine. Patients rated the pain of PDL injections and endodontic access on a visual analog scale. If moderate to severe pain was felt during treatment, the operator administered 1 set of supplemental PDL injections with 4% articaine with 1:100,000 epinephrine. If moderate to severe pain was felt again during treatment, the operator administered a second set of supplemental PDL injections. Anesthetic success was defined as having no to mild pain during endodontic treatment. ResultsThe success of the IANB with nitrous oxide was 44% (95% confidence interval [CI], 34%–54%). The overall anesthetic success rate (IANB with PDL injections) was increased from 69% (95% CI, 60%–78%) with 1 set of PDL injections to 80% (95% CI, 72%–88%) with a second set of PDL injections. ConclusionsAlthough the second set of PDL injections increased anesthetic success, it was not sufficient to ensure complete pulpal anesthesia.

Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars.

Materials and Methods This study was conducted on the mandibular first molars of 54 patients (35 males and 19 females) with signs and symptoms of SIP. To anesthetize the affected molars, all patients received a single carpule of 2% lidocaine with 1 : 100000 epinephrine using a standardized inferior alveolar nerve block (IANB) technique. The cold test was conducted before beginning the endodontic procedures and after gaining lip numbness, and the results were reported as either positive or negative response. The root canal preparation (RCP) was then initiated and the patients' responses were documented (Gold standard test). True pulpal anesthetic failure was described as a pain perception during the access cavity and pulp tissue removal. True pulpal anesthesia was defined as no pain or discomfort during the access cavity and pulp extirpation. The qualitative variables frequencies and percentages of patients with true/false positive and negative responses were determined and then compared using the Chi-square test. The pain perception of male and female patients during the cold test and gold standard was compared using the Fisher exact test. The following diagnostic parameters were calculated using an online statistical calculator: sensitivity, specificity, predictive values, accuracy, and Youden index. In addition, a receiver operating characteristic curve (ROC) was constructed and the area under the curve (AUC) was calculated. Results The overall percentage of actual failure of pupal anesthesia was 57%. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden index for the cold test were 0.87, 0.91, 0.93, 0.84, 0.89, and 0.78, respectively. There was no statistically significant difference between male and female patients regarding their responses to cold testing and the gold standard test (P > 0.05). Besides, the patients' reactions to the cold test were significantly matched with their reactions to the gold standard test (P < 0.05). The area under the ROC was mostly 0.9. Conclusion The cold test could be a valuable and accurate method for predicting the potential pupal anesthesia before beginning the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis, particularly after obtaining postanesthetic soft tissue numbness.

Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial.

ObjectivesThis randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS).Materials and MethodsThis study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests.ResultsThe piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP.ConclusionsBuccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial.

BackgroundThe efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp.MethodsOne hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment.ResultsThe rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups.ConclusionPreoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis.

This randomized, active-controlled, double-blind, prospective clinical trial evaluated the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine versus an admixture of 2% lidocaine with 1:200,000 epinephrine and 1 mL of 4 mg dexamethasone (Twin mix) for inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP) of the mandibular molars. Seventy-eight patients with SIP of mandibular molars were randomly allocated to the 2 groups of 39 subjects. All patients were required to have profound lip numbness within 10 minutes of local anesthetic deposition. The efficacy of pulpal anesthesia was confirmed by absence of pain or mild pain (Heft-Parker visual analogue scale ≤54 mm) during access cavity preparation and placement of glide path files. The collected data were subjected to independent t test, chi-square test, and Fisher exact test using SPSS software version 20.0 at a significance level of 0.05. IANB success rates for the lidocaine group and the Twin mix group was 66% and 68% respectively, which was not a statistically significant difference (p > .05). This study demonstrated that the anesthetic efficacy of Twin mix was equivalent to 2% lidocaine for IANBs in teeth with SIP.

Anesthetic Efficacy of Lidocaine/Ketorolac in Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Randomized Clinical Trial.

Objective:The purpose of this randomized, double-blind study was to evaluate the anesthetic efficacy of lidocaine-ketorolac administration by Inferior Alveolar Nerve Block (IANB) in patients with irreversible pulpitis.Methods:Eighty-eight adult patients received a combination of either one cartridge of “2% lidocaine with 1:80.000 epinephrine” (Li) plus one cartridge of a mixture of 0.8 mL of the same solution and 1mL ketorolac tromethamine (KT)(30 mg/mL), or one cartridge of Li solution plus one cartridge of a mixture of the same solution and saline. Endodontic access was prepared after fifteen minutes. Anesthetic success was defined as no or mild pain [less than 54 mm on the Heft-Parker visual analog scale (HP-VAS)] during access cavity preparation and initial file insertion. Chi-square test was used for data analysis, and the level of significance was set at 0.05 (P=0.05).Results:Results showed that the success rates were 34.1% and 27.3% for Li-KT and Li-Saline groups, respectively, with no significant difference between the two groups (P=0.48). However, significant decrease of baseline mean VAS pain score of the participants in both groups was found during access cavity preparation or initial file insertion (P<0.05).Conclusion:Mixed Li-KT solution did not increase the success rate of IANB injection significantly.

Comparative Evaluation of Effect of Preoperative Oral Medication of Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis:A Randomized Clinical Trial

Aim: The purpose of this randomized control study was to determine the effect of the administration of the preoperative ketorolac on the success of the inferior alveolar nerve (IAN) block in patients with symptomatic irreversible pulpitis Materials and Method: Ninety adult volunteers who were actively experiencing pain participated in this study. The subjects were divided into 3 groups on a random basis and were randomly divided into three groups. Group 1 patients were advised to take tablet Ketorol-DT for 2 days as per the dosage recommendation by the manufacturer before the endodontic procedure. Group 2 patients were given tablet Ketorol-DT 1 hour before anesthesia and group 3 patients receive no preoperative medication. All patients received standard inferior alveolar nerve block of 2% lidocaine with 1:80,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of initial inferior alveolar nerve block. Pain during treatment was recorded by using Heft Parker visual analog scale. Success was recorded as none or mild pain. Result: Preoperative administration of tablet Ketorol-DT before 2days has a significant effect on success rate of Inferior alveolar nerve block in patients with irreversible pulpitis. There is no statistical difference between group 2 and group 3. Conclusion: Preoperative administration of tablet Ketorol-DT before 2days has a significant effect on success rate of Inferior alveolar nerve block in patients with Irreversible pulpitis.

Comparative Evaluation of Preoperative Methylprednisolone or Ibuprofen on Anesthetic Efficacy of Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis

Comparative Evaluation of Preoperative Methylprednisolone or Ibuprofen on Anesthetic Efficacy of Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis

Cryotherapy may increase the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis who undergo endodontic treatment

Cryotherapy may increase the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis who undergo endodontic treatment

The Effect of Cryotherapy Application on the Success Rate of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

IntroductionThis randomized clinical trial assessed the effect of preoperative intraoral cryotherapy application on the success rate of inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP). MethodsOne hundred four patients with SIP were randomly distributed into 2 groups: control and cryotherapy groups. In the control group, patients received an IANB injection with 2% lidocaine. In the cryotherapy group, intraoral cryotherapy application was performed for 5 minutes after the IANB. Endodontic therapy was then conducted 15 minutes after the IANB injection. If the patients reported moderate or severe pain during the procedure, the IANB was defined as “unsuccessful,” and a supplementary injection was administered. ResultsAll patients reported profound lip numbness. The overall success rate for the IANBs was 43.3%. In the cryotherapy group, the success rate of the IANBs was 55.8%, whereas in the control group it was 30.8% (P < .05). ConclusionsIntraoral cryotherapy application increased the success rate of IANBs in mandibular molar teeth with SIP. However, supplemental anesthesia techniques may still be required to provide profound pulpal anesthesia in many cases.

Efficacy of local anaesthetic solutions on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a systematic review and network meta-analysis of randomized clinical trials.

The management of pain during root canal treatment is important. The aim of this systematic review and network meta-analysis was to identify the anaesthetic solution that would provide the best pulpal anaesthesia for inferior alveolar nerve blocks (IANB) treating mandibular teeth with irreversible pulpitis. Two electronic databases (PubMed and Scopus) were searched to identify studies up to October 2018. Randomized clinical trials comparing at least two anaesthetic solutions (lidocaine (lignocaine), articaine, bupivacaine, prilocaine or mepivacaine) used for IANB for treatment of irreversible pulpitis were included. The revised Cochrane risk of bias tool for randomized trials was used to assess the quality of the included studies. Pairwise meta-analysis, network meta-analysis using a random-effects model, and SUCRA ranking were performed. The network meta-analysis estimated the probability of each treatment performing best. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. In total, 11 studies (n=750) were included in the meta-analysis. The network meta-analysis revealed that only mepivacaine significantly increased the success rate of IANB compared to lidocaine (RR, 1.42 [95% CI 1.04-1.95]). However, no significant differences in the success rate of IANB were observed between mepivacaine and other anaesthetic agents (articaine and bupivacaine). Of all anaesthetic agents, mepivacaine (SUCRA=0.81) ranked first in increasing the success rate of IANB, followed by prilocaine (SUCRA=0.62), articaine (SUCRA=0.54), bupivacaine (SUCRA=0.41) and lidocaine (SUCRA=0.13). The overall quality of evidence was very low to moderate. In conclusion, based on the evidence from the randomized clinical trials included in this review, mepivacaine with epinephrine demonstrated the highest probability of providing effective pulpal anaesthesia using IANB for teeth with irreversible pulpitis compared to prilocaine, articaine, bupivacaine and lidocaine. Further, high-quality clinical trials are needed to support the conclusion of this review.