A recent double-blinded, randomized controlled trial carried out by the Baqai Medical University Dental College has unveiled that administering preoperative analgesics significantly boosts the efficacy of inferior alveolar nerve blocks (IANB) in patients with symptomatic irreversible pulpitis. This study, published in the prestigious European Endodontic Journal, sheds light on a very common issue encountered in dental clinics worldwide, promising improved patient comfort and treatment outcomes.

The Study Parameters

The study, conducted under the guidance of Dr. Maryam M. Riaz and her team, encompassed 120 patients who were to receive root canal treatment for mandibular molars diagnosed with symptomatic irreversible pulpitis. The patients were randomly segregated into four groups, each receiving different preoperative regimes:

Group A (Control): Vitamin E (Evion 400 mg)
Group B: Diclofenac sodium (Voltral SR100 100 mg)
Group C: Piroxicam (Feldene 20 mg)
Group D: Tramadol (Tramal 50 mg)

Participants were asked to report their pain levels using the Heft-Parker visual analogue scale before and after analgesic administration, which was then followed by the local anesthetic IANB.

The Findings

In the study, published with DOI 10.14744/eej.2023.42650 and appearing on pages 246 to 252 in the August 2023 issue of European Endodontic Journal (Volume 8, Issue 4), it was noted that all analgesic groups experienced a considerable enhancement in IANB effectiveness compared to the control group. Remarkably, none of the drug groups showed statistically significant differences amongst each other regarding improved nerve block efficiency.

Implications for Dental Practice

Dr. Farjad Zafar, an expert in dental implantology and co-author of the study, elucidates the potential of these findings: “Management of pain is crucial in endodontic treatments. Our study suggests that simple premedication may enhance anesthesia efficiency, which is particularly instrumental in instances where achieving profound anesthesia is challenging, such as in cases with symptomatic irreversible pulpitis.”

Safety Profile

An essential element of this study is the reported absence of side effects associated with the administered preoperative analgesics, reinforcing the safety profile of these medications.

Potential Practice Revisions

The authors of this study, including Dr. Zara Khalid and Dr. Tipu Sultan from departments of Operative Dentistry and Endodontics and Periodontology respectively, advocate for the adoption of preoperative analgesics in clinical practice. Aisha Wali, from the Research and Development department, adds, “This could be a game-changer for many patients who dread root canal treatments due to associated pain. Preemptive analgesia can significantly ease patient anxiety and discomfort.”

Expert Opinions

Regarding the implications of these findings, Dr. Talha Mufeed Siddiqui, co-author and a specialist in Operative Dentistry and Endodontics, shared, “The implications extend beyond pain management; by improving IANB effectiveness, we may also reduce the number of appointments and procedural intervals, directly impacting the economics and patient productivity.”

Recommendations for Further Research

While this research has addressed a vital aspect of endodontic treatment, it opens avenues for comparative studies involving different analgesic regimens, as well as long-term assessments of the impact of preemptive analgesia on postoperative outcomes and patient satisfaction.


1. Riaz, M. M., Zafar, F., Khalid, Z., Sultan, T., Wali, A., & Siddiqui, T. M. (2023). Comparison of Preoperative Analgesics on the Efficacy of Inferior Alveolar Nerve Block with Patients Having Symptomatic Irreversible Pulpitis: A Double-Blinded, Randomized Controlled Trial. European Endodontic Journal, 8(4), 246–252. DOI: 10.14744/eej.2023.42650

2. Singh, N. R., Mishra, L., Pawar, A. M., Kurniawati, N., Wahjuningrum, D. A. (2022). Comparative evaluation of the effect of two pulpal medicaments on pain and bleeding status of mandibular molars with irreversible pulpitis post-failure of inferior alveolar nerve block: a double-blind, randomized, clinical trial. PeerJ, 10:e13397. DOI: 10.7717/peerj.13397

3. Aggarwal, V., Singla, M., Subbiya, A., Vivekanandhan, P., Sharma, V., & Sharma, R. (2015). Effect of preoperative pain on inferior alveolar nerve block. Anesth Prog., 62(4), 135-139. DOI: 10.2344/anpr-62-04-01

4. Faghihian, H., Faghihian, R., Khademi, A., Aggarwal, V. (2020). Anesthetic efficacy of Lidocaine/Ketorolac in inferior alveolar nerve block in patients with irreversible pulpitis: a randomized clinical trial. European Endodontic Journal, 5(3), 186-190. DOI: 10.14744/eej.2020.26362

5. Nagendrababu, V., Duncan, H. F., Bjørndal, L., Kvist, T., Priya, E., Jayaraman, J. et al. (2020). PRIRATE 2020 guidelines for reporting randomized trials in Endodontics: a consensus-based development. International Endodontic Journal, 53(6), 764-773. DOI: 10.1111/iej.13334


1. Inferior Alveolar Nerve Block
2. Preoperative Analgesics Effectiveness
3. Symptomatic Irreversible Pulpitis Treatment
4. Dental Pain Management
5. Endodontic Anesthesia Research

This article illuminates a significant development in dental treatment protocols and suggests a paradigm shift in preoperative analgesic administration, particularly for patients with potentially challenging dental conditions such as symptomatic irreversible pulpitis. With its focus on improving patient outcomes and comfort, this research is of substantial interest to dental practitioners and patients alike.