*7.1.4 Intrapulpal anesthesia*

Intrapulpal anesthesia is one of the supplementary anesthesia that is beneficial, especially in a hot tooth. The most crucial aspect of this technique is to pump the fluid into the pulp forcefully. If the physician does not feel pressure or resistance to injection, the solution is not reaching the pulp and is most likely running out of the pulp chamber and back into the access cavity [39]. However, this type of anesthesia is excruciating and should only be used as the last option during endodontic therapy. Intrapulpal anesthesia has the drawback of having a limited duration of effect. As a result, it's critical to remove the pulp from all of the root canals as soon as possible after injection to avoid repeated injection [40]. It is necessary that the patient should be informed that the type of anesthesia will cause moderate to severe discomfort in the beginning.

## **7.2 Buffered anesthesia**

Buffered local anesthesia technique to one of the techniques to improve the efficiency of the local anesthetics. Alkalinization accelerates the dissociation of the LA molecule, increasing in the uncharged base form that penetrates the nerve membrane and acts in the intraneuronal location. The addition of sodium bicarbonate is the most frequent technique for buffering LAs. The addition of sodium bicarbonate to local anesthetics reacts to form sodium chloride water and carbon dioxide. Alkalinization with sodium bicarbonate raise the pH of the solution. Carbon dioxide produces an independent anesthetic effect by changing the local anesthetic inside the nerve direct depressant effect of carbon dioxide on the nerve axon [41]. 50 mEq is the maximum dose of sodium bicarbonate. 20 ml of 1 or 2% lignocaine is recommended to be added with 2 ml of 8.4 percent sodium bicarbonate. The ratio of lignocaine to bicarbonate should be between 5:1 and 10:1 for best effects. If the bicarbonate level exceeds this ratio, precipitation may occur. In individuals with metabolic acidosis and hypocalcemia, this method is contraindicated [15].
