الفهرس 
Title : Effect of preoperative acetaminophen- codeine-caffeine combination on inferior alveolar nerve block success in patients with symptomatic irreversible pulpitis: randomized double-blind controlled trial
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Abstract
The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the effect of preoperative administration of acetaminophen-codeine-caffeine combination on the inferior alveolar nerve block (IANB) success versus acetaminophen alone or placebo in patients with symptomatic irreversible pulpitis (SIP) in their mandibular molars.
Methods: Eighty-one patients, aged 20-50 years with no sex predilection, diagnosed with SIP in their mandibular molars, were randomly allocated into three groups (n = 27). Preoperative pain was recorded on the Numerical Rating scale (NRS). One hour before endodontic treatment, patients received a pretreatment, single oral dose of either 1000 mg acetaminophen-16 mg codeine-60 mg caffeine combination (group A), 1000 mg acetaminophen alone (group B), or placebo (group C). After 15 minutes from a standard IANB injection with 1.8 ml 2% mepivacaine and 1:20 000 levonordefrin, the teeth were isolated and access cavity preparation was initiated, followed by instrumentation until full length of the root canals. Pain was recorded one-hour postmedication and during access/instrumentation using NRS. Success was defined as no or mild pain during access cavity preparation and/or instrumentation. All demographic data and NRS scores were collected from the patients and statistically analyzed. p-value of significance was set at (p <0.05).
Results: Success rates of IANB in Groups A, B, and C were 61.5%, 51.9%, and 44.4%, respectively, with no statistically significant difference among the three groups. There was a significant difference in one-hour postmedication pain intensity among the three groups (p = 0.001); Groups A and B showed statistically significantly lower postmedication pain intensity than group C.
Conclusions: A single oral dose of 1000 mg acetaminophen-16 mg codeine-60 mg caffeine combination one hour before IANB administration could be as effective as 1000 mg acetaminophen alone or placebo regarding the success rate of IANB in patients with SIP in their mandibular molars.