Table 4. Summary of the evidence and quality of the findings (GRADE).[34].
Buffered lidocaine compared to non-buffered lidocaine for injection pain, onset time, percentage of painless injection, and success rate in mandibular nerve block | |||||
---|---|---|---|---|---|
Outcomes | No. of participants(studies) Follow-up | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
Risk with non-buffered lidocaine | Risk difference with buffered lidocaine | ||||
Injection pain for IANB using VAS | 232 (5 RCTs) | ⊕⊕⊕⊖ | N/A | The mean difference in injection pain was 5.0 VAS Units lower in buffered group (9.13 lower to 0.77 lower) | |
MODERATEa | |||||
Onset time (seconds) | 160 (2 RCTs) | ⊕⊕⊖⊖ | N/A | The mean difference in onset time was 48.23 seconds lower in buffered group (42.06 lower to 54.40 lower) | |
LOWa,b | |||||
The percentage of patients with painless IANB injection | 216 (3 RCTs) | ⊕⊕⊕⊖ | RR 2.903 (0.961 to 8.771) | 324 per 1,000 | 617 more participants per 1,000 (13 fewer to 2,518 more) in buffered group than in the non-buffered group |
MODERATEa | |||||
Anesthetic success rate | 180 (2 RCTs) | ⊕⊕⊖⊖ | RR 1.208 (0.852 to 1.713) | 389 per 1,000 | 81 more participants per 1,000 (58 fewer to 277 more) in buffered group than in the non-buffered group |
LOWa,b | |||||
CI: Confidence interval; RR: Risk ratio N/A: Not applicable | |||||
GRADE Working Group grades of evidence | |||||
High certainty: Authors are very confident that the true effect lies close to that of the estimate of the effect | |||||
Moderate certainty: Authors are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different | |||||
Low certainty: Authors' confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect | |||||
Very low certainty: Authors have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect |
aHigh magnitude of statistical heterogeneity I2 > 50%, statistically significant heterogeneity Q P-value < .10
bSmall number of studies, small sample size.