Comparative Evaluation of the Efficacy and Onset of Local Anesthesia Using Buffered 2% Lidocaine with 1:100,000 Adrenaline and Non-Buffered 2% Lido caine with 1:100,000 Adrenaline in Dental Extraction – A Clinical Study
DOI:
https://doi.org/10.48165/ajm.2026.9.01.14Keywords:
Buffered local anesthesia, lidocaine, onset time, dental extraction, pain perceptionAbstract
Aim: To comparatively evaluate the onset time and efficacy of buffered 2% lidocaine with 1:100,000 adrenaline and non-buffered 2% lidocaine with 1:100,000 adrenaline in patients undergoing dental extraction. Materials and Methods: This randomized, single-blind clinical study was conducted on 40 patients indicated for simple dental extraction. The patients were randomly divided into two groups (n = 20 each). Group I received non-buffered 2% lidocaine with 1:100,000 adrenaline, while Group II received buffered 2% lidocaine with 1:100,000 adrenaline. The buffered solution was prepared by adding 8.4% sodium bicarbonate to the anesthetic solution immediately before administration. The onset time of anesthesia was recorded using a stopwatch from completion of injection to the first subjective sign of numbness. Pain during injection and pain during extraction were assessed using a Visual Analog Scale (VAS). The need for supplementary anesthesia was also recorded. Statistical analysis was performed using the independent t-test and Chi-square test, with the level of significance set at p < 0.05. Results: The buffered lidocaine group demonstrated a significantly faster onset of anesthesia compared to the non-buffered group (p < 0.05). Pain scores during injection and during extraction were significantly lower in the buffered group. Additionally, fewer patients in the buffered group required supplementary anesthesia. Conclusion: Buffered 2% lidocaine with 1:100,000 adrenaline provides faster onset and improved anesthetic efficacy with reduced pain perception compared to non-buffered lidocaine during dental extraction. Its use may enhance patient comfort and clinical efficiency in routine dental practice.Downloads
References
Reed, K. L., Malamed, S. F., & Fonner, A. M. (2012). Local anesthesia part 2: Technical considerations. Anesthesia Progress, 59(3), 127–136.
Decloux, D., & Ouanounou, A. (2020). Local anaesthesia in dentistry: A review. International Dental Journal, 71(2), 87–95.
Tole, N., & Neeli, A. (2024). Evaluation of the efficacy of buffered local anesthetic in extraction of infected teeth: Randomized double-blind study. Oral and Maxillofacial Surgery, 28(2), 803–807.
Vent, A., Surber, C., Johansen, G., Tracy, N., Figueiredo, V., Schönbächler, G., Imhof, L., Buset, C., & Hafner, J. (2020). Buffered lidocaine 1%/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. Journal of the American Academy of Dermatology, 83(1), 159–165.
Abou Agwa, T., Sakka, S., Al-Jundi, A., & Gazal, G. (2024). Effect of adding sodium bicarbonate 8.4% to local anesthesia on pain during upper canine infiltration. Saudi Journal of Anaesthesia, 18(4), 504–508.
Palanivel, I., Ramakrishnan, K., Narayanan, V., Chandran, S., & Gurram, P. (2020). A prospective, randomized, double-blinded, crossover comparison of buffered versus nonbuffered 2% lidocaine with 1:80,000 adrenaline for dental extraction. International Journal of Applied Dental Sciences, 6(1), 35–38.
Kalra, G., Makkar, S., Menrai, N., Kalia, V., Suri, N., & Gupta, S. (2023). Comparative evaluation of the efficacy and onset of local anesthesia using buffered 2% lidocaine with 1:100,000 adrenaline and nonbuffered 2% lidocaine with 1:100,000 adrenaline in dental extraction. Journal of Maxillofacial and Oral Surgery, 23(5), 1255–1260.
AlShehabi, I. Y., AlAjami, M., Orabi, M. F., & Khudair, H. (2020). Evaluation of the efficiency of lidocaine 2% with epinephrine 1:80,000 buffered by sodium bicarbonate during regional anesthesia: A clinical study. International Journal of Applied Dental Sciences, 6(2), 105–109.
Fatima, S., Ishaq, M., Khan, A. A., Nadeem, R., Saeed, Z., & Zaidi, S. S. (2025). Comparison of buffered with standard local anesthesia in odontogenic infections: A randomized controlled trial. Journal of Population Therapeutics and Clinical Pharmacology. Advance online publication.
Aulestia-Viera, P. V., Braga, M. M., & Borsatti, M. A. (2018). Do buffered local anesthetics provide more successful anesthesia than nonbuffered solutions in patients with pulpally involved teeth requiring dental therapy? A systematic review and meta-analysis. International Endodontic Journal, 51(8), 862–876.
