Fentanyl provides effective supplemental analgesia in dental surgery for pulpitis

NEW YORK (Reuters Health) March 17 An interligamentary injection of fentanyl provides superior pain relief in dental debridement when added to standard local anesthesia than does local anesthesia alone, Egyptian endodontists report in the February Journal of Pain and Symptom Management.

Standard pain relief in dental debridement relies on interligamentary injections of mepivacaine and epinephrine. However, local analgesia is often inadequate because the acid environment created by the inflammation prevents uptake of the anesthetic, principal investigator Dr. Eman A. Elsharrawy and colleagues at October 6 University in Cairo point out.

Forty patients with irreversible pulpitis received an initial interligamentary injection of 1.8 ml of 2% mepivacaine plus epinephrine 1:200,000, which is standard therapy for dental debridement.

Patients were then randomized to receive supplemental fentanyl, 0.4 ml in a 0.05 mg/ml solution added to a supplementary course of 0.4 ml 2% mepivacaine with epinephrine 1:200,000 or to supplemental local anesthesia alone. The drugs were given in two divided doses, with 0.2 ml given on the mesial side of the tooth and 2 ml given distally.

Fentanyl provided significantly greater pain relief during various stages of surgery, including no pain on pulp extraction, than the standard approach with mepivacaine plus epinephrine. Patients randomized to local anesthesia only experienced more pain at all stages of surgery.

The findings "confirm the importance of peripheral opioid actions in inflammatory pain and suggest the value of this approach for the clinic," Dr. Elsharrawy and colleagues write. In contrast with its effect on local anesthetic agents, an acid environment produces "enhanced opioid effects."

J Pain Symptom Manage 2007;33:203-207.

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