Clinical evaluation of intrapulpal injection of fentanyl for management of acute irreversible pulpitis’ pain

Abstract EN

Background : Fentanyl is a fully-synthetic opioid that was tried effectively in periodontal ligament injection with minimal doses.

Aim : to investigate the efficacy and safety of intrapulpal injection of fentanyl as a supplemental technique in management of pain in patients with acute irreversible pulpitis during endodontic treatment, through comparative study with saline and mepivacaine / adrenaline 1:200,000.

Patients and Methods : This study was conducted on 60 adult healthy patients presented with acute symptomatic irreversible pulpitis of lower first molar tooth due to caries or multiple restorations.

Diagnosis was based on the dental history and clinical examination, which made use of provoking stimuli.

Patients who met the criteria of the study, were randomly divided into 3 equal groups : group I (Mepivacaine group), group II (Fentanyl group) and group III (Saline group).

All selected patients were assessed prior to giving the nerve block as a standard anesthetic technique by rating their pain intensity on the five points scale assessed by the dentist.

Patients’ response during the procedure was rated on a five point rating scale during access cavity preparation, pulpotomy and pulp extirpation stages consequently.

Results : Fentanyl had a high significant difference in relieving pain intensity scores throughout different stages of endodontic debridement.

During pulp extirpation stage, fentanyl recorded a significant decrease in pain intensity in comparison to mepivacaine and saline groups.

Conclusion: It has been concluded that intrapulpal injection of fentanyl provided more profound analgesia than mepivacaine and saline, continued during different stages of the endodontic debridement procedure.

It is highly effective and could be used as supplemental anesthesia in the presence of inflamed pulp.