Endodontist University of Washington Asheville, North Carolina
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Post-operative pain is one of the biggest challenges to endodontics and is one that has persisted throughout the history of root canal treatment. Many factors have been investigated as to whether or not they are predictive for post-operative pain, as well as intraoperative techniques that attempted to reduce post-operative pain. The aim of this pilot study was to investigate if there are any differences in post-operative pain when two different anesthetics, bupivacaine or lidocaine, are administered following root canal treatment. This was a randomized, single-blind, clinical trial of healthy adult patients at the University of Washington Graduate Endodontic Clinic who were diagnosed with irreversible pulpitis of a posterior mandibular tooth. Following pulpal debridement at the first visit, patients were randomized and received an additional IANb with either 2% lidocaine 1:100,000 epinephrine, or 0.5% bupivacaine 1:200,000 epinephrine. Participants were asked to track post-operative pain levels at 6,12,24,48 and 72 hours using a visual analog scale as well as post operative analgesic use. Four patients were included in the study with seven in each group, each of which had similar pre-operative pain levels. The bupivacaine group had significantly less pain at 6 and 72 hours compared to the lidocaine group with overall less pain at all time points. No significant differences were observed in analgesic use between the groups. Patients receiving an inferior alveolar nerve block with 0.5% bupivacaine following root canal treatment on a vital mandibular posterior tooth, experienced significantly less pain at 6 and 72 hours post operatively.
