Non-Cochrane · intervention · PM41640719
Effectiveness of buffered local anesthetic solutions in pediatric nerve blocks and infiltration anesthesia: a systematic review and meta-analysis.
Bhatnagar Akash, Gupta Disha · Journal of dental anesthesia and pain medicine · 2026 · PubMed · doi:10.17245/jdapm.2026.26.1.19
Findings
Population Children aged 4 to 12 years undergoing dental procedures requiring local anesthesia
3 findings
| Buffered local anesthetic (8.4% sodium bicarbonate added to lidocaine or articaine) | Unbuffered (conventional) local anesthetic | Onset time of anesthesia During injection / procedure · Pediatric dental procedures (infiltration and inferior alveolar nerve block) · Overall (random-effects) | SMD -1.55 [-3.67, 0.57] GRADE not reported 4 studies · 355 participants |
| Buffered local anesthetic (8.4% sodium bicarbonate added to lidocaine or articaine) | Unbuffered (conventional) local anesthetic | Objective pain response (SEM, OSUBRS) During injection / procedure · Pediatric dental procedures (infiltration and inferior alveolar nerve block) · Overall (random-effects) | SMD -0.53 [-1.20, 0.15] GRADE not reported 3 studies · 226 participants |
| Buffered local anesthetic (8.4% sodium bicarbonate added to lidocaine or articaine) | Unbuffered (conventional) local anesthetic | Subjective pain perception during injection (WBFPRS, HP-VAS) During injection / procedure · Pediatric dental procedures (infiltration and inferior alveolar nerve block) · Overall (random-effects) | SMD -0.59 [-1.00, -0.17] GRADE not reported 3 studies · 295 participants |
Included primary studies 5
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Afsal 2019 Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures DOI:10.17245/jdapm.2019.19.2.101 | 2019 | 1 other review | Onset time of anesthesia; Subjective pain perception during injection (WBFPRS, HP-VAS); Objective pain response (SEM, OSUBRS) | not extracted yet |
| Chopra 2016 Double-Blind Crossover Study to Compare Pain Experience During Inferior Alveolar Nerve Block Administration Using Buffered Two Percent… PMID:26892211 | 2016 | this review only | Onset time of anesthesia; Objective pain response (SEM, OSUBRS) | not extracted yet |
| Dhake 2022 Buffered articaine infiltration for primary maxillary molar extractions: a randomized controlled study DOI:10.17245/jdapm.2022.22.5.387 | 2022 | this review only | Onset time of anesthesia; Subjective pain perception during injection (WBFPRS, HP-VAS); Objective pain response (SEM, OSUBRS) | not extracted yet |
| Kurien 2018 Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve… DOI:10.15171/joddd.2018.016 | 2018 | this review only | not stated | not extracted yet |
| Meincken 2019 Anesthesia Onset Time and Injection Pain Between Buffered and Unbuffered Lidocaine Used as Local Anesthetic for Dental Care in Children. PMID:31648665 | 2019 | this review only | Onset time of anesthesia; Subjective pain perception during injection (WBFPRS, HP-VAS) | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Articaine versus lidocaine for local anesthesia in pediatric dental procedures: an umbrella review of systematic reviews and meta-analyses. (2026) | 1 | 0.04 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children aged 4-12 years undergoing dental procedures requiring local anesthesia | Children aged 4-12 years (n=273 across 5 RCTs) |
| Intervention | Buffered local anesthetic agents | Buffered lignocaine or articaine with 8.4% sodium bicarbonate (n=5) |
| Comparison | Unbuffered (conventional) local anesthetic agents | Unbuffered lignocaine or articaine (n=5); pre-warmed lignocaine arm in 1 study |
| Outcomes | Onset time of anesthesia; subjective pain perception; objective pain response | Onset of anesthesia (n=4 meta-analyzed); subjective pain (n=3); objective pain (n=3) |
| Study designs | RCTs, double- or single-blind trials, crossover or split-mouth studies | 5 RCTs (2 crossover, 2 split-mouth, 1 triple-blind parallel) |
| Timing | Not specified | At injection |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |