Submitted 16 May 2022 Accepted 14 September 2022 Published 19 October 2022 Corresponding authors Dian Agustin Wahjuningrum, dian- agustin-w@fkg.unair.ac.id Ajinkya M. Pawar, ajinkya@drpawars.com Academic editor Luca Testarelli Additional Information and Declarations can be found on page 10 DOI 10.7717/peerj.14187 Copyright 2022 Gandhi et al. Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS Evaluation of pulpal anesthesia and injection pain using IANB with pre- heated, buffered and conventional 2% lignocaine in teeth with symptomatic irreversible pulpitis—a randomized clinical study Namita Gandhi 1 , Nimisha Shah 1 , Dian Agustin Wahjuningrum 2 , Sweetly Purnomo 2 , Riana Nooshian 3 , Suraj Arora 4 and Ajinkya M. Pawar 3 1 Department of Conservative Dentistry and Endodontics, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India 2 Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya City, East Java, Indonesia 3 Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashtra, India 4 Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia ABSTRACT Background. The efficacy of 2% lignocaine is reduced in a hot tooth. Local aesthetic agents can be preheated and buffered to increase their effectiveness. The present investigation was carried out due to limited information concerning adult patients with symptomatic irreversible pulpitis in mandibular teeth. Methods. A total of 252 individuals were included in the clinical trial in accordance with the selection criteria only after clinical study was registered with the Clinical Trial Registry of India (CTRI/2020/09/027796). Scores on the visual analog scale (VAS) and electric pulp test (EPT) on a 1–10 scale were recorded prior to the commencement of therapy. In this double-blinded study, patients were randomly divided by a co- investigator using computer randomisation (www.randomizer.org) into three groups, group A: inferior alveolar nerve blocks (IANB) with 2% lignocaine preheated at 42 ◦ C (injected at 37 ◦ C) (N = 84), group B: IANB of 2% lignocaine buffered with 0.18 ml of 8.4% sodium bicarbonate (N = 80) and group C: 2% lignocaine (N = 88). Excluding the dropouts of individuals (n = 11), wherein the anaesthesia failed, a total of 241 people were finally assessed 15 minutes after profound anaesthesia, endodontic access, and intraoperative pain were quantified using VAS. Pain on injection for all three groups was recorded immediately after IANB with VAS. The analysis was performed using one way ANOVA with Tukey’s post hoc test and Paired T-Test using SPSS version 21. Results. Preheated, Buffered, and conventional 2% lignocaine showed statistically significant reduction in intraoperative pain (P < 0.001) compared to pre-operative but on inter-group comparison preheated and buffered showed highly significant pain reduction compared with conventional 2% lignocaine (P < 0.001). Conclusions. Warm and buffered local anaesthetic (LA) were effective in reducing intraoperative discomfort than conventional LA. Preheated local anesthetics caused the How to cite this article Gandhi N, Shah N, Wahjuningrum DA, Purnomo S, Nooshian R, Arora S, Pawar AM. 2022. Evaluation of pulpal anesthesia and injection pain using IANB with pre-heated, buffered and conventional 2% lignocaine in teeth with symptomatic irreversible pulpitis—a randomized clinical study. PeerJ 10:e14187 http://doi.org/10.7717/peerj.14187