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Symptomatic Irreversible PulpitisPhase 4NCT02110966

Mepivacaine-Tramadol on the Success of Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis

A Phase 4 study testing Mepivacaine and Mepivacaine plus Tramadol in people with Symptomatic Irreversible Pulpitis, run by Daniel Chavarría Bolaños at 1 site in Mexico.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to evaluate the success of inferior alveolar nerve block, after the local application of Mepivacaine plus Tramadol in patients with symptomatic irreversible pulpitis. Read more about this study

Who is it for?
Ages 18 to 50 yearsHealthy volunteers can take part
Conditions the study is for
Symptomatic Irreversible Pulpitis
What is being tested?
Mepivacaine and Mepivacaine plus Tramadol
Could I receive a placebo?
No, everyone receives an active treatment
How many people
56 participants
Where
1 siteMexico
Study dates
Apr 2014to Oct 2014
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 50 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Subjects diagnosed with symptomatic irreversible pulpitis in the first and second mandibular molars.

Who cannot join

  • Pregnancy
  • Hypersensitivity to local anesthetics and Tramadol
  • Teeth with insufficient tooth structure for restoration, periodontal disease, root resorption, root fracture
  • Systemic diseases: diabetes, uncontrolled hypertension.
  • Patients taking drugs or narcotics.
  • Patients who have used analgesics in the last 8 hours.
Show all 9Show fewer
  • Patients ingested IMAOS and tricyclic antidepressants 14 days before.
  • Patients ingested carbamazepine (anticonvulsants)
  • Patients in active treatment with ketoconazole and erythromycin.

Trial locations and contacts

1 site in 1 country.

Mexico1 site
  • Endodontics Master Degree program, Dentistry Faculty, San Luis Potosi University

    San Luis Potosí City, San Luis Potosí, 78290

Other trials in Mexico

About this study

Official title: Efficacy of the Combination Mepivacaine-Tramadol on the Success of Inferior Alveolar Nerve Block in Patients With Symptomatic Irreversible Pulpitis: a Randomized Clinical Trial.

The purpose of this study is to evaluate the success of inferior alveolar nerve block, after the local application of Mepivacaine plus Tramadol in patients with symptomatic irreversible pulpitis. Also, to evaluate the duration of the anesthetic effect when using Mepivacaine plus Tramadol in the same anesthetic technique and patients group.

Hypothesis:

Local application of mepivacaine plus tramadol increases the successful of inferior alveolar nerve block in patients with irreversible pulpitis.

Read the detailed description

The treatment of pain is an integral part of Endodontics, this must be controlled before, during and after treatment. The inferior alveolar nerve block is the most common anesthetic technique used in mandibular teeth during endodontic treatments. Several studies have reported that it is more difficult to obtain anesthetic success in patients with irreversible pulpitis. There is a 33-80% of failure in the inferior alveolar nerve block in patients with irreversible pulpitis.

Some of the more accepted theories for local anesthetic failure establish that inflammation induce tissue acidosis causing ion traping of the local anesthetics enabling the molecules to cross the cell membrane, also inflammatory mediators may sensitize the neurons by interacting with specific receptors leading to periphery sensibilization. Tissue injury may alter the composition, distribution and activity of sodium channels expressed on nociceptors and this may have profound implications in local anesthetic failure. On the other hand, there is a specific group of tetrodotoxin resistant sodium channels four times less sensitive to lidocaine which increase their activity during inflammation.

Some ways to control pain is through pharmacological synergism. Tramadol has been proposed as pharmacological adjuvant to local anesthesia and it can improve the anesthetics success and the duration of the anesthetic effect. However, oral administration of drugs can cause adverse systemic effects, and that's why local application is an alternative to increase its concentration on the local damaged tissue reducing the possibility of interactions with other drugs and adverse effects. Another advantage of the combination of Mepivacaine with Tramadol is that it reduces the number of injections in patients and it is less traumatic.

Tramadol is centrally acting drug but also a local anesthetic and analgesic effect it has been reported. It acts at multiple sites producing different action mechanisms. Some studies suggest that the use of Tramadol can improve the effect of Mepivacaine in the inferior alveolar nerve block. The blockade of the nervous conduction with Tramadol is 80% more effective if it is compared with some anesthetics like lidocaine.

There are few studies evaluating local application of tramadol. In the field of dentistry tramadol using for local anesthetic adjuvant has been studied in oral surgery, so it is important to evaluate it in the field of endodontics to provide better pain management during treatments.

Thus, the aim of the study is to evaluate the success of inferior alveolar nerve block with the local application of Mepivacaine plus Tramadol in patients with symptomatic irreversible pulpitis, and also to evaluate the duration of the anesthetic effect when using Mepivacaine plus Tramadol in the anesthetic technique. This study was designed as a double-blind, randomized clinical trial. Following the guidelines suggested by CONSORT group for planning and reporting clinical trials. The ethics committee of the Faculty of Dentistry of San Luis Potosi University approved the study design. All of the subjects will be informed of the possible risk of endodontic therapy and experimental treatments and will sign institutionally approved consents forms.

In total 50 patients will be included in this study. The sample size calculation was performed with a Type I error of 0.05 and statical power of 80% using the difference in duration of anesthetic effect between two groups and taking into account previous studies related to the local effect of tramadol in clinical studies where it is used to assess the time of anesthetic effect.

All the subjects voluntarily will presented at the Postgraduate Endodontics Clinic of the Faculty of Dentistry at San Luis Potosi University. The select subjects will have a diagnosis of symptomatic irreversible pulpitis in the first and second mandibular molars.

The patients will be diagnosing with the cold test and they will indicate their pain scores using numerical rating scale, this is a 11 point scale where the ends points are the extremes of no pain and the worst pain. Accordingly, no pain corresponded with 0, mild pain with 1-3, moderate pain with 4-6 and severe pain 7-10. The control group will receive the inferior alveolar nerve block using 1.8 ml of Mepivacaine 2% epinephrine 1: 100000 and 1.3 ml of Mepivacaine 2% epinephrine 1:100000 mixed with 0.5 ml of Tramadol (50mg/ml) will be used for the anaesthetic blockade in the experimental group. After 15 minutes, the anesthetic blockade will be assessed by a three step examination: lip numbess, positive/negative response to cold testing and clinical discomfort during endodontic access. Inferior alveolar nerve block success will be defined as the absence of pain during any of these evaluations and if patients report pain an analogue visual scale will be used.

Statics normal distribution will be tested by the student's t test. A non-parametric chi- squared test was performed to identify statistically differences between the groups; the level of significance was set at p˂ 0.05.

Being tested
Mepivacaine, Mepivacaine plus Tramadol
Keywords
Anaesthetic effect, Inferior alveolar nerve block, Local tramadol, Mepivacaine, Symptomatic irreversible pulpitis.

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MepivacaineDrug

    Also called Dentocaín

    Drug: Tramadol 1.8 ml of Mepivacaine 2% epinephrine 1:100000.

  • Mepivacaine plus TramadolDrug

    Also called Tradol

    0.5 ml of Tramadol mixed with 1.3 ml of Mepivacaine.

Study groups in NCT02110966
Study groupRoleWhat they receive
Mepivacaine plus TramadolExperimental1.3 ml of Mepivacaine 2% epinephrine 1:100000 mixed with 0.5 ml of Tramadol (50mg/ml) will be used for the anesthetic blockade in the experimental group
Receives: Drug: Mepivacaine plus Tramadol
MepivacaineActive comparatorThe control group will receive the inferior alveolar nerve block using 1.8 ml of Mepivacaine 2% epinephrine 1: 100000.
Receives: Drug: Mepivacaine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. success of the inferior alveolar nerve block

    The anesthetic blockade will be assessed by a three step examination: lip numbess, positive/negative response to cold testing and clinical discomfort during endodontic access. Inferior alveolar nerve block success will be defined as the absence of pain during any of these evaluations and if patients report pain an analogue visual scale will be used. Also, the patient will reported the level of pain in the application of the inferior alveolar nerve block using mepivacaine and mepivacaine plus tramadol and local and systemic side effects will be monitored.

    Measured: 0-30 minutes

Secondary outcomes (1)
  1. Anesthetic effect duration

    The time of the anesthetic effect will be evaluated in patients in whom anesthetic success is achieved, and also the consume of emergency and rescue post-operative analgesics. Side effects will also be monitored during this period.

    Measured: 0-14 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Apr 2014 (estimated)
  2. Study startApr 2014
  3. Primary completionOct 2014
  4. Study completionOct 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
56 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02110966
Sponsor's protocol ID
CEIFE-008-014
Status last verified
Oct 2014
First submitted
8 Apr 2014
Last updated
31 Oct 2014
Results posted
No
Data monitoring committee
No

Publications

  • Walton RE, Torabinejad M. Managing local anesthesia problems in the endodontic patient. J Am Dent Assoc. 1992 May;123(5):97-102. doi: 10.14219/jada.archive.1992.0133.

    PubMed 1597649
  • Hellstrom PM, Husebye E, Kraglund K. Methodology for motility studies on the small intestine: a Scandinavian consensus. Eur J Surg Suppl. 1991;(564):51-61. No abstract available.

    PubMed 1718505
  • Cohen HP, Cha BY, Spangberg LS. Endodontic anesthesia in mandibular molars: a clinical study. J Endod. 1993 Jul;19(7):370-3. doi: 10.1016/S0099-2399(06)81366-X.

    PubMed 8245762
  • Henry MA, Hargreaves KM. Peripheral mechanisms of odontogenic pain. Dent Clin North Am. 2007 Jan;51(1):19-44, v. doi: 10.1016/j.cden.2006.09.007.

    PubMed 17185058
  • Noguera-Gonzalez D, Cerda-Cristerna BI, Chavarria-Bolanos D, Flores-Reyes H, Pozos-Guillen A. Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J. 2013 Nov;46(11):1056-62. doi: 10.1111/iej.12099. Epub 2013 Apr 6.

    PubMed 23561002
  • Kargi E, Babuccu O, Altunkaya H, Hosnuter M, Ozer Y, Babuccu B, Payasli C. Tramadol as a local anaesthetic in tendon repair surgery of the hand. J Int Med Res. 2008 Sep-Oct;36(5):971-8. doi: 10.1177/147323000803600513.

    PubMed 18831890
  • Sawynok J. Topical and peripherally acting analgesics. Pharmacol Rev. 2003 Mar;55(1):1-20. doi: 10.1124/pr.55.1.1.

    PubMed 12615951
  • Stein C, Lang LJ. Peripheral mechanisms of opioid analgesia. Curr Opin Pharmacol. 2009 Feb;9(1):3-8. doi: 10.1016/j.coph.2008.12.009. Epub 2009 Jan 20.

    PubMed 19157985
  • Isiordia-Espinoza MA, Pozos-Guillen AJ, Martinez-Rider R, Herrera-Abarca JE, Perez-Urizar J. Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery. Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16(6):e776-80. doi: 10.4317/medoral.16854.

    PubMed 21217614
  • Wang JT, Chung CC, Whitehead RA, Schwarz SK, Ries CR, MacLeod BA. Effects of local tramadol administration on peripheral glutamate-induced nociceptive behaviour in mice. Can J Anaesth. 2010 Jul;57(7):659-63. doi: 10.1007/s12630-010-9301-9. Epub 2010 Mar 26.

    PubMed 20340056
  • Robaux S, Blunt C, Viel E, Cuvillon P, Nouguier P, Dautel G, Boileau S, Girard F, Bouaziz H. Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently. Anesth Analg. 2004 Apr;98(4):1172-1177. doi: 10.1213/01.ANE.0000108966.84797.72.

    PubMed 15041620
  • Guven M, Mert T, Gunay I. Effects of tramadol on nerve action potentials in rat: comparisons with benzocaine and lidocaine. Int J Neurosci. 2005 Mar;115(3):339-49. doi: 10.1080/00207450590520948.

    PubMed 15804720
  • Isiordia-Espinoza MA, Orozco-Solis M, Tobias-Azua FJ, Mendez-Gutierrez EP. Submucous tramadol increases the anesthetic efficacy of mepivacaine with epinephrine in inferior alveolar nerve block. Br J Oral Maxillofac Surg. 2012 Mar;50(2):157-60. doi: 10.1016/j.bjoms.2011.02.010. Epub 2011 May 8.

    PubMed 21555171
  • Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, Babuccu O. The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic. Anesth Analg. 2004 Nov;99(5):1461-1464. doi: 10.1213/01.ANE.0000135640.21229.A0.

    PubMed 15502049
  • Pozos AJ, Martinez R, Aguirre P, Perez J. The effects of tramadol added to articaine on anesthesia duration. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):614-7. doi: 10.1016/j.tripleo.2006.01.017. Epub 2006 Jul 27.

    PubMed 17052637

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Mepivacaine and Mepivacaine plus Tramadol in people with Symptomatic Irreversible Pulpitis, run by Daniel Chavarría Bolaños at 1 site in Mexico.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 Oct 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Mexico. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

success of the inferior alveolar nerve block (time frame: 0-30 minutes). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02110966, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Oct 2014.

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