Introduction: To achieve painless treatment in patients with a failed primary IANB,
supplementary anaesthesia has been advised. The majority of the studies evaluating
intraligamentary injections have been performed on asymptomatic teeth. Very limited research
has been dedicated to the evaluation of different variables in intraligamentary injections in
patients with symptomatic irreversible pulpitis Aim: To evaluate the anaesthetic efficacy of
2% lidocaine with 1:80 000 epinephrine vs. 2% lidocaine with 1:80 000 epinephrine plus
tramadol hydrochloride (50 mg, 1:1 v/v ratio), given as intraligamentary injections after a
failed inferior alveolar nerve block (IANB), in patients with symptomatic irreversible
pulpitis. Objective: 1. To achieve painless treatment in patients with a failed primary IANB.
during the endodontic management of symptomatic mandibular first/second molar. 2. To evaluate
the heart rate during and after intraligamentary injections Methods: This prospective,
randomized, double-blind clinical trial will be carried out by Conservative Dentistry,
Faculty Of Dentistry, Jamia Millia Islamia. Sixty adult patients with symptomatic
irreversible pulpits in a mandibular first or second molar will receive an initial IANB with
2% lidocaine with 1:80 000 epinephrine. Pain during the endodontic treatment will be assessed
using a visual analogue scale(VAS). Patients experiencing pain on endodontic intervention
shall be randomly allocated to one of the two treatment groups: one group shall receive 0.6
mL/ root of supplementary intraligamentary injection of 2% lidocaine with 1:80 000
epinephrine; while the second group shall receive 2% lidocaine with 1:80 000 epinephrine plus
tramadol hydrochloride (50 mg, 1:1 v/v ratio). Endodontic treatment will be re-initiated.
Success after primary injection or supplementary injection will be defined as no or mild pain
(less than 55 mm on HP VAS) during access preparation and root canal instrumentation. Heart
rate will be monitored using a finger pulse oximeter by a faculty member. Statistical
analysis: The results will be tabulated in contingency tables. The anaesthetic success rates
will be analyzed with the Pearson chi-square test at 5% significance levels. The heart rate
changes will be analyzed using a t-test.