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

• Main Authors: Moghadamnia A, Partovi M, Mohammadianfar I, Madani Z, Zabihi E, Hamidi M, Baradaran M
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2009-01-01
• Series: Indian Journal of Dental Research
• Subjects: Amitriptyline; endodentics; irreversible pulpitis; local anesthesia; tricyclic antidepressants
• Online Access: http://www.ijdr.in/article.asp?issn=0970-9290;year=2009;volume=20;issue=1;spage=3;epage=6;aulast=Moghadamnia

<b>Background: </b> 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&#x0025; Amitriptyline local gel administration in irreversible pulpitis pain of the molars. <b> Materials and Methods: </b> 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&#x0025; 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. <b> Results: </b> There was a 92.5&#x0025; 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&#x0025;. Further, in the amitriptyline group, the VAS score at all timepoints was statistically different from Time 0 (<i> P</i> &#60; 0.01). The overall pain reduction and its trend was significantly higher in the amitriptyline group compared with the placebo group (<i> P</i> &#60; 0.001). <b> Conclusion: </b> Inter-pulp space administration of amitriptyline 2&#x0025; gel for completing analgesia in irreversible pulpitis pain could be effective and useful as a conjunctive therapy to injections of local anesthetics.