Sodium bicarbonate-buffered lidocaine may be superior to nonbuffered lidocaine in reducing onset time and injection pain during inferior alveolar nerve block (IANB), according to a systematic review published in the Journal of Dental Anesthesia and Pain Medicine.

For this systematic review, investigators examined randomized, double-blind studies from several databases, including PubMed, Web of Science, Cochrane Library, Embase, and Proquest that evaluated the use of buffered vs nonbuffered lidocaine during IANB (n=11). Study outcomes included onset time, injection pain assessed using a visual analog scale (VAS), percentage of painless injections, and anesthetic success rate of IANB.

The risk for bias was unclear in 10 of the 11 studies and high in 1 study. Buffered vs nonbuffered lidocaine was found to have a faster onset time (48-second difference; 95% CI, −42.06 to −54.40; P <.001), and lower VAS injection pain score (5.0-unit reduction on a scale of 0 to 100; 95% CI, −9.13 to −0.77; P =.02). The percentage of participants with painless injection (P =.059) and success rate (P =.290) were comparable in both groups.

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However, the researchers cautioned that the studies included in their review had low-to-moderate quality evidence and that additional studies with larger numbers of participants and low risks for bias are needed to confirm these results.

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Guo J, Yin K, Roges R, Enciso R. Efficacy of sodium bicarbonate buffered versus non-buffered lidocaine with epinephrine in inferior alveolar nerve block: a meta-analysis. J Dent Anesth Pain Med. 2018;18:129-142.