Pain relief in irreversible pulpitis cases with inferior alveolar nerve block is difficult, more-so in the case of mandibular molars. The present study evaluated the effect of premedication with non-steroidal anti-inflammatory drugs on local anaesthesia during endodontic therapy. In a prospective, randomised, double blinded clinical trial, 75 patients (25 per group) with symptomatic irreversible pulpitis were selected. They were given either placebo, 600 mg ibuprofen, or 7.5mg meloxicam an hour before local anaesthesia. Each participant recorded their pain score on a 10 centimetre visual analogue scale four times during the procedure. Pain was recorded: 1) before taking the analgesic, 2) 15 minutes after anaesthesia in response to an electric pulp test, 3) during access cavity preparation and 4) during biomechanical preparation. No or mild pain at any stage was reported as success. Data were analysed by the Kruskal-Wallis and one way analysis of variance tests. Ibuprofen and meloxicam showed significantly better results than placebo (p<0.05). The success rates were 92%, 88% and 60% for ibuprofen, meloxicam and placebo, respectively. There was no significant difference between ibuprofen and meloxicam (p>0.05). The study concludes premedication with ibuprofen and meloxicam significantly enhances the effectiveness of local anaesthesia in patients with irreversible pulpitis.

Keywords: Anaesthesia, inferior alveolar nerve block, irreversible pulpitis, placebo, premedication.

1. O’Keefe EM. Pain in endodontic therapy: Preliminary study. J Endod 1976;2:315-19.
2. Hargreaves KM. Neurochemical factors in injury and inflammation in orofacial tissues. In: Lavigne G, Lund J, Sessle B, Dubner R, eds. Orofacial pain: Basic sciences to clinical management. Chicago: Quintessence, 2001;45-52.
3. Jastak J, Yagiela J, Donaldson D. Local anaesthetic of the oral cavity. Philadelphia: Sanders, 1995:1-339.

1. Potočnik I, Bajrović F. Failure of inferior alveolar nerve block in endodontics. Endod Dent Traumatol 1999;15:247–51. 
2. Ingle JI, Walton RE, Malamed SF. Preparation for endodontic treatment. In: Ingle JI, Bakland LK, eds. Endodontics. 5th edn. Hamilton: BC Decker, 2002;385.

6. Trowbridge H, Emling R. Chemical mediators of the vascular response. In: Inflammation: a review of the process, 5th edn. Chicago: Quintessence, 1997:33.
7. Dionne RA, Campbell RA, Cooper SA, Hall DL, Buckingham B. Suppression of postoperative pain by preoperative administration of ibuprofen in comparison to placebo, acetaminophen, and acetaminophen plus codeine. J ClinPharmacol 1983;23:37–43.
8. Cooper SA. Five studies on ibuprofen for postsurgical dental pain. Am J Med 1984;77:70 –7.
9. Dionne RA, Cooper SA. Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars. Oral Surg Oral Med Oral Pathol 1978; 45:851– 6.
10. Parirokh M, Ashouri R, Rekabi AR, Nakhaee N, Pardakhti A, Askarifard S, Abbott PV. The effect of premedication with ibuprofen and indomethacin on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod2010; 36:1450-4.
11. Aggarwal V, Singla M, Debipada K. Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: A prospective double-blind randomized clinical trial. J Endod 2010;102:399-403.
12. Del Tacca, R. Colucci, M. Fornai, C. Blandizzi. Efficacy and Tolerability of Meloxicam, a COX-2 Preferential Nonsteroidal Anti-Inflammatory Drug. Clin Drug Invest 2002;22.
13. Sayeed Attar, Walter R. Bowles, Michael K. Baisden. Evaluation of pre-treatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod 2008;34:652-5.
14. Coll AM, Ameen JR, Moseley LG. Reported pain after day surgery: a critical literature review. J AdvNurs 2004;46:53– 65.
15. Goddard G, Karibe H, McNeill C. Reproducibility of visual analog scale (VAS) pain scores to mechanical pressure. Cranio 2004;22:250–6.
16. Bigby J, Reader A, Nusstein J, Beck M. Anaesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 2007;33: 7-10.10
17. McLean C, Reader A, Beck M, Meryers WJ. An evaluation of 4% prilocaine and 3% meperidine compared with 2% lidocaine for IANB. J Endod 1993;19:146-50.
18. Seymour R, Ward P. Evaluation of different dosages of soluble ibuprofen and ibuprofen tablets in postoperative dental pain. Br J Oral MaxillofacSurg 1996;34:110-4.
19. Orozco-Solís M, García-Ávalos Y, Pichardo Ramírez C, Tobías-Azúa F, Zapata-Morales JR, Aragon-Martínez OH, Isiordia-Espinoza MA.Single dose of diclofenac or meloxicam for control of pain, facial swelling, and trismus in oral surgery. Med Oral Patol Oral Cir Bucal 2016;21:e127–e134.
20. Modaresi J, Dianat O, Mozayeni MA. The efficacy of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anaesthesia during treatment of inflamed teeth. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2006;102:399-403.

Dr Suman Lamba

KIST Medical College, GPO Box: 14142,

Mahalaxmi Municipality, Ward No. 1, Lalitpur, NEPAL

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.