Effect of local anesthesia stored at different temperatures and its influence on pain perception in children: A randomized clinical trial

Nallanchakrava, Srinivas; Enabothula, Sohini; Mallela, George MK; HM, Niharika

doi:10.37841/jidam.2025.v12.i1.001

3

Study Groups

25

References

2025

Year Published

📝Abstract

Background

Administration of local anesthesia (LA) is vital in invasive dental procedures, particularly in children as it invokes pain leading to uncooperative behavior and ensures future compliance. Inadequate anesthesia can lead to procedure failure, heightening fear and anxiety. Techniques to minimize pain include application of topical anesthesia, buffering with sodium bicarbonate, using fine needles, and delivery of LA agent slowly. Recent studies focus on adjusting the temperature of LA solution and its effects on pain, with observations showing decreased pain during administration.

Aim

To evaluate pain perception and onset of action on administration of local anesthetic solution (LA) at different temperatures.

Settings & Design

The study was conducted in the Department of Pediatric and Preventive Dentistry. It is a randomized, controlled, three-arm study with individuals in the age group of 6 to 12 years.

Methods

Group 1: Lignocaine at 45°C. Group 2: Lignocaine at 4°C. Group 3: Lignocaine stored at room temperature 25–30°C. Pain was assessed using WONG-BAKERS FACES PAIN SCALE. Statistical analysis: One-Way ANOVA tests and Post-Hoc Tukey Tests were used.

Results

Pre-warmed and cooled local anesthetic solutions resulted in less pain on injection and faster onset of action when compared with conventional local anesthesia stored at room temperature.

Conclusions

Pre-warming and pre-cooling the anesthetic solution reduced pain on administration and during the procedures in children. Temperature modification of local anesthetic solutions is a simple, effective method to improve patient comfort in paediatric dentistry.

Keywords: Local Anesthesia Pain Perception Paediatric Dentistry Temperature Randomized Clinical Trial Wong-Baker Scale

🔖How to Cite

Nallanchakrava S, Enabothula S, Mallela GMK, Niharika HM. Effect of local anesthesia stored at different temperatures and its influence on pain perception in children: A randomized clinical trial. J Indian Dent Assoc Madras. 2025;12(1):1. DOI: 10.37841/jidam.2025.v12.i1.001

Nallanchakrava, S., Enabothula, S., Mallela, G. M. K., & Niharika, H. M. (2025). Effect of local anesthesia stored at different temperatures and its influence on pain perception in children: A randomized clinical trial. Journal of Indian Dental Association Madras, 12(1), 1. https://doi.org/10.37841/jidam.2025.v12.i1.001

Nallanchakrava, Srinivas, et al. "Effect of local anesthesia stored at different temperatures and its influence on pain perception in children: A randomized clinical trial." Journal of Indian Dental Association Madras, vol. 12, no. 1, 2025, p. 1. DOI: 10.37841/jidam.2025.v12.i1.001.

Nallanchakrava S, Enabothula S, Mallela GMK, Niharika HM. Effect of local anesthesia stored at different temperatures and its influence on pain perception in children. J Indian Dent Assoc Madras. 2025;12(1):1. doi:10.37841/jidam.2025.v12.i1.001

Nallanchakrava, Srinivas, Sohini Enabothula, George MK Mallela, and Niharika HM. "Effect of Local Anesthesia Stored at Different Temperatures and Its Influence on Pain Perception in Children: A Randomized Clinical Trial." Journal of Indian Dental Association Madras 12, no. 1 (2025): 1. https://doi.org/10.37841/jidam.2025.v12.i1.001.

📚References

1
Covino BG, Vassallo HG. Local anesthetics: mechanisms of action and clinical use. New York: Grune & Stratton, 1976.
2
Tirupathi SP, Rajasekhar S. Effect of warming local anesthesia solutions before intraoral administration in dentistry: a systematic review. J Dent Anesth Pain Med. 2020;20(4):187–94.
3
Cheng JL, MacDonald MJ. Effect of heat stress on vascular outcomes in humans. J Appl Physiol (1985). 2019;126(3):771–81.
4
Vidhya N, Karthikeyan BS, Velmurugan N, Abarajithan M, Nithyanandan S. Interaction between lidocaine hydrochloride (with and without adrenaline) and various irrigants: A nuclear magnetic resonance analysis. Dent Res J. 2014;11(3):395–9.
5
Dabarakis N, Tsirlis A, Parisis N, Tsoukalas D. The role of temperature in the action of mepivacaine. Anesth Prog. 2006;53(3):91–4.
6
Kurien RS, Goswami M, Singh S. Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: A randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2018;12(2):102–9.
7
Roshni Chandran. Pain Assessment in Children Using a Modified Wong Baker Faces Pain Rating Scale. Int J Clin Prev Dent. 2019;15(4):202–5.
8
Baier K, Milgrom P, Russell S, Mancl L, Yoshida T. Children's fear and behavior in private pediatric dentistry practices. Pediatr Dent. 2004;26(4):316–21.
9
El Sayed M, Gaballah K. Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars. Int J Dent. 2021; Article ID 9913221.
10
Bahar E, Yoon H. Lidocaine: A Local Anesthetic, Its Adverse Effects and Management. Medicina. 2021;57(8):782.
11
Decloux D, Ouanounou A. Local anaesthesia in dentistry: a review. Int Dent J. 2020;71(2):87–95.
12
Boopathi T, Sebeena M, Sivakumar K, Harikaran J, Karthick K, Raj A. Supplemental pulpal anesthesia for mandibular teeth. J Pharm Bioallied Sci. 2013;5(Suppl 1):S103–8.
13
Bell RW, Butt ZA, Gardner RF. Warming lignocaine reduces the pain of injection during local anaesthetic eyelid surgery. Eye. 1996;10(Pt 5):558–60.
14
Alonso PE, Perula LA, Rioja LF. Pain-temperature relation in the application of local anaesthesia. Br J Plast Surg. 1993;46(1):76–8.
15
Valiulla MUE, Halli R, Khandelwal S, Mittal A, Singh A, Bhindora K. Efficacy of Sodium Bicarbonate-Buffered Local Anesthetic Solution in Cases Requiring Bilateral Maxillary Premolar Orthodontic Extraction: A Comparative Split-Mouth Study. Cureus. 2023;15(4):e37934.
16
Davidson JA, Boom SJ. Warming lignocaine to reduce pain associated with injection. BMJ. 1992;305(6854):617–8.
17
Allen MJ, Bunce C, Presland AH. The effect of warming local anaesthetic on the pain of injection during sub-Tenon's anaesthesia for cataract surgery. Anaesthesia. 2008;63(3):276–8.
18
Powell MF. Stability of lidocaine in aqueous solution: effect of temperature, pH, buffer, and metal ions on amide hydrolysis. Pharm Res. 1987;4(1):42–5.
19
Bainbridge LC. Comparison of room temperature and body temperature local anaesthetic solutions. Br J Plast Surg. 1991;44(2):147–8.
20
Rogers KB, Fielding AF, Markiewicz SW. The effect of warming local anesthetic solutions prior to injection. Gen Dent. 1989;37(6):496–9.
21
Aravena PC, Barrientos C, Troncoso C, Coronado C, Sotelo-Hitschfeld P. Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial. Local Reg Anesth. 2018;11:9–13.
22
Rood JP. The temperature of local anaesthetic solutions. J Dent. 1977;5(3):213–4.
23
Ram D, Hermida LB, Peretz B. A comparison of warmed and room-temperature anesthetic for local anesthesia in children. Pediatr Dent. 2002;24(4):333–6.
24
Hogan ME, vanderVaart S, Perampaladas K, Machado M, Einarson TR, Taddio A. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;58(1):86–98.
25
Khatri A, Kalra N. A comparison of two pain scales in the assessment of dental pain in East Delhi children. ISRN Dent. 2012;247351.

[1] 1
Covino BG, Vassallo HG. Local anesthetics: mechanisms of action and clinical use. New York: Grune & Stratton, 1976.

[2] 2
Tirupathi SP, Rajasekhar S. Effect of warming local anesthesia solutions before intraoral administration in dentistry: a systematic review. J Dent Anesth Pain Med. 2020;20(4):187–94.

[3] 3
Cheng JL, MacDonald MJ. Effect of heat stress on vascular outcomes in humans. J Appl Physiol (1985). 2019;126(3):771–81.

[4] 4
Vidhya N, Karthikeyan BS, Velmurugan N, Abarajithan M, Nithyanandan S. Interaction between lidocaine hydrochloride (with and without adrenaline) and various irrigants: A nuclear magnetic resonance analysis. Dent Res J. 2014;11(3):395–9.

[5] 5
Dabarakis N, Tsirlis A, Parisis N, Tsoukalas D. The role of temperature in the action of mepivacaine. Anesth Prog. 2006;53(3):91–4.

[6] 6
Kurien RS, Goswami M, Singh S. Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: A randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2018;12(2):102–9.

[7] 7
Roshni Chandran. Pain Assessment in Children Using a Modified Wong Baker Faces Pain Rating Scale. Int J Clin Prev Dent. 2019;15(4):202–5.

[8] 8
Baier K, Milgrom P, Russell S, Mancl L, Yoshida T. Children's fear and behavior in private pediatric dentistry practices. Pediatr Dent. 2004;26(4):316–21.

[9] 9
El Sayed M, Gaballah K. Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars. Int J Dent. 2021; Article ID 9913221.

[10] 10
Bahar E, Yoon H. Lidocaine: A Local Anesthetic, Its Adverse Effects and Management. Medicina. 2021;57(8):782.

[11] 11
Decloux D, Ouanounou A. Local anaesthesia in dentistry: a review. Int Dent J. 2020;71(2):87–95.

[12] 12
Boopathi T, Sebeena M, Sivakumar K, Harikaran J, Karthick K, Raj A. Supplemental pulpal anesthesia for mandibular teeth. J Pharm Bioallied Sci. 2013;5(Suppl 1):S103–8.

[13] 13
Bell RW, Butt ZA, Gardner RF. Warming lignocaine reduces the pain of injection during local anaesthetic eyelid surgery. Eye. 1996;10(Pt 5):558–60.

[14] 14
Alonso PE, Perula LA, Rioja LF. Pain-temperature relation in the application of local anaesthesia. Br J Plast Surg. 1993;46(1):76–8.

[15] 15
Valiulla MUE, Halli R, Khandelwal S, Mittal A, Singh A, Bhindora K. Efficacy of Sodium Bicarbonate-Buffered Local Anesthetic Solution in Cases Requiring Bilateral Maxillary Premolar Orthodontic Extraction: A Comparative Split-Mouth Study. Cureus. 2023;15(4):e37934.

[16] 16
Davidson JA, Boom SJ. Warming lignocaine to reduce pain associated with injection. BMJ. 1992;305(6854):617–8.

[17] 17
Allen MJ, Bunce C, Presland AH. The effect of warming local anaesthetic on the pain of injection during sub-Tenon's anaesthesia for cataract surgery. Anaesthesia. 2008;63(3):276–8.

[18] 18
Powell MF. Stability of lidocaine in aqueous solution: effect of temperature, pH, buffer, and metal ions on amide hydrolysis. Pharm Res. 1987;4(1):42–5.

[19] 19
Bainbridge LC. Comparison of room temperature and body temperature local anaesthetic solutions. Br J Plast Surg. 1991;44(2):147–8.

[20] 20
Rogers KB, Fielding AF, Markiewicz SW. The effect of warming local anesthetic solutions prior to injection. Gen Dent. 1989;37(6):496–9.

[21] 21
Aravena PC, Barrientos C, Troncoso C, Coronado C, Sotelo-Hitschfeld P. Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial. Local Reg Anesth. 2018;11:9–13.

[22] 22
Rood JP. The temperature of local anaesthetic solutions. J Dent. 1977;5(3):213–4.

[23] 23
Ram D, Hermida LB, Peretz B. A comparison of warmed and room-temperature anesthetic for local anesthesia in children. Pediatr Dent. 2002;24(4):333–6.

[24] 24
Hogan ME, vanderVaart S, Perampaladas K, Machado M, Einarson TR, Taddio A. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;58(1):86–98.

[25] 25
Khatri A, Kalra N. A comparison of two pain scales in the assessment of dental pain in East Delhi children. ISRN Dent. 2012;247351.