Comparison of 0.75% ropivacaine and 2% lignocaine with adrenaline for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A double-blind, split-mouth clinical study

Aim: To evaluate the efficacy of an alternative anesthetic, 0.75% ropivacaine, compared to 2% lidocaine with 1:80,000 epinephrine in symptomatic irreversible pulpitis. Efficacy was assessed based on the success of pulpal anesthesia, measured by patient response to cold test and need for additional anesthetic injections. Methods: This double-blind, randomized, split-mouth, and prospective study included twenty systemically healthy outpatients requiring root canal treatment on both sides of the mandible. Each patient received both 1.8 ml of 0.75% ropivacaine and 1.8 ml of 2% lidocaine hydrochloride with adrenaline in separate appointments, determined by randomization. Pain scores were recorded using the Visual Analog Scale, and success rates were evaluated using a cold test. Results: No statistically significant difference was found in pain scores between the ropivacaine and lidocaine groups during dentin ( U = 189.00, P = 0.739) and pulp chamber ( U = 165.5, P = 0.311) procedures. However, significant differences were observed during file insertion in the canal, with the ropivacaine group experiencing significantly lower pain (mean score 2.00) compared to the lidocaine group (mean score 3.30) ( U = 104.0, P = 0.008). Ropivacaine demonstrated a higher success rate (80%) compared with lidocaine (45%). Conclusion: 0.75% ropivacaine represents a safe and adrenaline-free alternative for inferior alveolar nerve blocks, providing effective intraoperative anesthesia for mandibular molars.