Adding Tramadol hydrochloride to a solution of 2% Lidocaine with 1:80,000 Epinephrine for supplementary intraligamentary injection boosts anesthetic success rates in pulpitis patients undergoing endodontic treatment procedures.

This randomized clinical controlled trial was performed to explore the efficacy of Tramadol alone or in combination with 2% Lidocaine as supplementary intraligamentary injections during endodontic treatment.

The initial subjects were selected from patients who presented to the dental emergency department with symptoms indicating irreversible pulpitis in mandibular molars. A total of 105 patients experiencing failed primary inferior alveolar nerve blocks (IANB) were randomized to three intraligamentary injection groups: 2% Lidocaine with 1:80,000 Epinephrine, Tramadol hydrochloride (50 mg/mL), and a combination of 2% Lidocaine with 1:80,000 Epinephrine plus Tramadol hydrochloride.

Each participant received 1.2 mL doses (0.6 mL per root). Anesthesia success was defined as pain ≤54 on the Heft-Parker visual analogue scale (VAS). Utilizing a finger pulse oximeter, heart rates were monitored. With the aid of the Pearson chi-square test, an analysis of anesthetic success rates, gender, and tooth type was done. Utilizing a one-way analysis of variance, heart rates and age were examined.  At p=0.05, significance was set.

The initial IANB success rate was 31%. Anesthetic success rates varied considerably among the different supplementary intraligamentary injection groups (χ2=33.6, p<0.001, df=2). The combination of 2% Lidocaine with Tramadol yielded remarkably higher success rates as opposed to the other two groups. Across all groups (p>0.05), baseline heart rates did not display profound differences.

Combining Tramadol with 2% Lidocaine and Epinephrine as supplementary intraligamentary injections can boost successful anesthesia in alleviating mandibular molars having irreversible pulpitis resistant to IANB injections during endodontic procedures.