Buffered versus unbuffered local anesthesia for inferior alveolar nerve block injections in children: a systematic review

BACKGROUND: The present study aimed to evaluate and compare the efficacy of buffered and unbuffered local anesthesia solutions during inferior alveolar nerve block (IANB) administration in children. METHODS: PubMed, Ovid SP, and Cochrane databases were searched separately by two independent reviewers for potential papers published between 1980 and April 2020 using relevant MeSH terms and pre-specified inclusion and exclusion criteria. T Studies of IANB administration in children comparing buffered and unbuffered local anesthesia solutions were evaluated. The primary outcome evaluated was pain (perception and reaction), while the secondary outcome was the onset of anesthesia. RESULTS: A total of five articles were included in a qualitative analysis; among them, four qualified for quantitative analysis of the primary outcome and three for quantitative analysis of the secondary outcome. A fixed-effects model was used to perform the meta-analysis. Pain perception (child-reported pain): Significantly lower pain scores were reported with buffered local anesthesia solution than with unbuffered solution (P = 0.006, MD: −0.32, 95% CI: −0.55 to −0.09). Pain reaction (observer-reported pain reaction in child): No significant difference was found between buffered and unbuffered solution in terms of observer-reported pain behavior in the child (P = 0.09, MD: −0.21, 95% CI: −0.46 to 0.04). Onset of anesthesia: A significantly lower duration of anesthesia onset was reported with buffered local anesthesia solution than with unbuffered solution (P = 0.00001, MD: −12.38, 95% CI: −17.64 to −7.13]. CONCLUSION: Buffering local anesthesia solution may reduce discomfort due to IANB injection administration and lower the initial onset time of anesthesia. More randomized control trials with adequate sample sizes should be carried out to validate the accuracy of these results.