Effectiveness of anti-inflammatory premedication on inferior alveolar nerve block success in acute irreversible pulpitis: a systematic review

Background: Irreversible pulpitis is commonly associated with reduced success of inferior alveolar nerve block (IANB) during root canal treatment, often leading to inadequate intraoperative pain control. Inflammatory mediators can decrease local anesthetic effectiveness and alter nerve response. Preoperative administration of anti-inflammatory drugs has been proposed as a strategy to improve anesthetic success. This review evaluates whether preoperative anti-inflammatory medication enhances the efficacy of IANB in patients with irreversible pulpitis. Methods: Thirteen articles published between 2014 and 2024 were included in the qualitative analysis following a screening of titles, abstracts, and full texts. The quality of the studies was assessed using the ROBINS tool. Results: Premedication with non-steroidal anti-inflammatory drugs or corticosteroids significantly improves the success of IANB in patients with symptomatic irreversible pulpitis. Success rates in treated groups generally range between 55% and 73%, compared to less than 40% in control groups. Ibuprofen, ketorolac, and dexamethasone were among the most effective agents. Discussion: Premedication with non-steroidal anti-inflammatory drugs or corticosteroids, especially ibuprofen and dexamethasone, improves the efficacy of IANB in symptomatic irreversible pulpitis, enhancing anesthetic success and reducing intraoperative pain.