Articaine plus morphine versus articaine alone for pain control during endodontic debridement in patients with irreversible pulpitis – a randomized controlled trial

Joanna Słowik, Tomasz Kaczmarczyk, Jadwiga Stypułkowska, Maria Chomyszyn-Gajewska, Małgorzata Zaleska, Anna Bednarczyk, Marcin Wnuk


Introduction: Standard local anaesthetics do not guarantee complete absence of pain during endodontic debridement of the inflamed pulp.

We investigated whether the addition of 1 mg of morphine to local articaine anaesthesia as compared to articaine alone could reduce pain sensations during endodontic debridement and within 48 h after the procedure.

Materials and methods: Thirty-two patients with pain attributed to irreversible pulpitis of the first upper molar participated in this randomized, double-blind trial. Patients were randomly assigned either to the study group (patients receiving periapical injection of modified local anaesthetic solution with morphine, n = 9) or to the control group (patients receiving standard anaesthetic solution without morphine, n = 23). The pain intensity was assessed using the visual analogue scale and verbal score before and directly after endodontic debridement, as well as at 1, 2, 6, 12, 24 and 48 h after the procedure.

Results: Neither the visual analogue scale nor verbal score differed between both groups before or during the endodontic debridement, as well as during 48-hour follow-up. However, there was an insignificant tendency for greater pain relief in patients treated with articaine and morphine at 12 h after endodontic debridement (p = 0.08). The study was funded by a Jagiellonian University in Poland (JU) grant, and was registered with the JU Ethical Committee No. 2008/K/ZDS/000518.

Conclusions: The addition of morphine to local articaine anaesthesia does not influence pain intensity in patients undergoing endodontic debridement in contrast to the previously described pain-relief effect in patients after oral surgery. However, future studies are needed to evaluate the role of opioids in local anaesthesia in endodontic procedures.


pulpitis; endodontic debridement; articaine; morphine; pain


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