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Background <p>Oral submucous fibrosis (OSMF) is a chronic, potentially malignant disorder characterized by progressive fibrosis of the oral mucosa, leading to restricted mouth opening and altered tissue physiology. These changes often compromise effectiveness of inferior alveolar nerve block (IANB).</p> Objective <p>Conventional 2% lignocaine with adrenaline is acidic, which may increase injection pain and delay anesthetic onset, especially in fibrotic tissues. Buffering local anesthetics with sodium bicarbonate increases solution pH, enhancing nerve penetration, accelerating onset, and improving patient comfort.</p> Methods <p>In this prospective, parallel-arm, randomized, triple-blind controlled trial, 160 patients aged 21–65 years with clinically diagnosed OSMF, interincisal mouth opening of 25–30&#xa0;mm, and requiring mandibular molar extraction were equally allocated to receive either buffered or non-buffered 2% lignocaine with adrenaline. Primary outcomes were subjective and objective onset times, with pain on injection was assessed using a 10-point VAS.</p> Result <p>Non-parametric analysis (Mann–Whitney U test with Holm–Bonferroni correction) showed significantly faster onset and lower pain scores in the buffered group (adjusted <i>p</i> &lt; 0.001), with very large effect sizes.</p> Conclusion <p>Buffered lignocaine offers superior anesthetic efficacy and patient comfort for IANB in OSMF patients, making chairside buffering a simple, effective clinical modification.</p>

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Effectiveness of non buffered and buffered local anesthesia in inferior alveolar nerve block in oral submucous fibrosis patient: randomized control trial

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Nishit K. Shah,
  • Ankur Padmaja,
  • Rajbir Kaur Randhawa,
  • Gagandeep Singh Randhawa,
  • Parth Raviya,
  • Yash Ajmera

摘要

Background

Oral submucous fibrosis (OSMF) is a chronic, potentially malignant disorder characterized by progressive fibrosis of the oral mucosa, leading to restricted mouth opening and altered tissue physiology. These changes often compromise effectiveness of inferior alveolar nerve block (IANB).

Objective

Conventional 2% lignocaine with adrenaline is acidic, which may increase injection pain and delay anesthetic onset, especially in fibrotic tissues. Buffering local anesthetics with sodium bicarbonate increases solution pH, enhancing nerve penetration, accelerating onset, and improving patient comfort.

Methods

In this prospective, parallel-arm, randomized, triple-blind controlled trial, 160 patients aged 21–65 years with clinically diagnosed OSMF, interincisal mouth opening of 25–30 mm, and requiring mandibular molar extraction were equally allocated to receive either buffered or non-buffered 2% lignocaine with adrenaline. Primary outcomes were subjective and objective onset times, with pain on injection was assessed using a 10-point VAS.

Result

Non-parametric analysis (Mann–Whitney U test with Holm–Bonferroni correction) showed significantly faster onset and lower pain scores in the buffered group (adjusted p < 0.001), with very large effect sizes.

Conclusion

Buffered lignocaine offers superior anesthetic efficacy and patient comfort for IANB in OSMF patients, making chairside buffering a simple, effective clinical modification.