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. 2018 Jun 29;18(3):129–142. doi: 10.17245/jdapm.2018.18.3.129

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.