Evaluation of the effect of locally administered amitriptyline gel as adjunct to local anesthetics in irreversible pulpitis pain

• Published in: Indian journal of dental research Vol. 20; no. 1; pp. 3 - 6
• Main Authors: Moghadamnia, A, Partovi, M, Mohammadianfar, I, Madani, Z, Zabihi, E, Hamidi, M, Baradaran, M
• Format: Journal Article
• Language: English
• Published: Mangalore Medknow Publications and Media Pvt. Ltd 01-01-2009; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Amitriptyline; Anesthesia; Complications and side effects; Dentistry; Dosage and administration; Drug therapy; endodentics; irreversible pulpitis; local anesthesia; Pain; Pulpitis; Risk factors; Teeth; tricyclic antidepressants; India
• ISSN: 0970-9290; 1998-3603
• DOI: 10.4103/0970-9290.49047

Background: Amitriptyline is one of the most common tricyclic antidepressants, which binds to pain sensory nerve fibers close to the sodium channel; hence, it could interact to some degree with receptors of local anesthetics. This study was designed to assess the additional analgesic effects of 2% Amitriptyline local gel administration in irreversible pulpitis pain of the molars. Materials and Methods: This study was a randomized, double-blind clinical trial that was performed on 56 consented adult patients who did not receive enough analgesia after a lidocaine nerve block for their tooth pulpitis pain. Patients were treated with 0.2 ml of either 2% amitriptyline or placebo, which was directly injected into their mandibular molar pulp chamber after they had received two routine lidocaine injections. Patients were asked to score their pain as a mark on a 10-cm Visual Analogue Scale (VAS) at different timepoints: 0 (just before gel administration), 1, 3, 5, 7, and 9 minutes after the treatments. Results: There was a 92.5% decrease in VAS scores of patients 9 minutes after amitriptyline administration compared to Time 0, while in the placebo group this difference was only 13.5%. Further, in the amitriptyline group, the VAS score at all timepoints was statistically different from Time 0 ( P < 0.01). The overall pain reduction and its trend was significantly higher in the amitriptyline group compared with the placebo group ( P < 0.001). Conclusion: Inter-pulp space administration of amitriptyline 2% gel for completing analgesia in irreversible pulpitis pain could be effective and useful as a conjunctive therapy to injections of local anesthetics.