Effect of Ketamine on Postendodontic Pain

INTERVENTION: Intervention 1: Oral suspension of ibuprofen, 600 mg, A single dose, 30 minutes before the initiation of treatment, Oral. Intervention 2: Placebo, A single dose, 30 minutes before the initiation of treatment, Oral. Intervention 3: Ketamine hydrochloride, 0.5mg/kg, A single dose, 30 minutes before the initiation of treatment, Oral. Ketamine hydrochloride, 0.5mg/kg, A single dose, 30 minutes before the initiation of treatment, Oral Oral suspension of ibuprofen, 600 mg, A single dose, 30 minutes before the initiation of treatment, Oral Placebo Placebo, A single dose, 30 minutes before the initiation of treatment, Oral Prevention CONDITION: K08.8, K04 Other specified disorders of teeth and supporting structures ‐ Toothache NOS and Pulpitis: acute Postoperative Endodontic Pain. ; Other specified disorders of teeth and supporting structures ‐ Toothache NOS and Pulpitis: acute PRIMARY OUTCOME: Pain intensity. Timepoint: Before and at 2, 4, 8, 12 and 24h after treatment. Method of measurement: Visual Analog Scale. SECONDARY OUTCOME: The incidence of side effects. Timepoint: Until 24h after treatment. Method of measurement: Questionnaire. The need for additional medication. Timepoint: Until 24h after treatment. Method of measurement: Questionnaire. The number of rescue analgesic tablets taken. Timepoint: Until 24h after treatment. Method of measurement: Questionnaire. Time to first request for rescue analgesic. Timepoint: Until 24h after treatment. Method of measurement: Questionnaire. INCLUSION CRITERIA: INCLUSION CRITERIA: 1. Patient elects root canal therapy for pain originating from a first or second mandibular molar. 2. The diagnosis of irreversible pulpitis is confirmed by a chief complaint of spontaneous pain and cold test application causing an elevated and lingering pain response. 3. The patient presented with American Society of Anesthesiologists (ASA) I or II medical history. 4. Patient reads and understands questionnaires. 5. Patient reports spontaneous pain above 3cm on a VAS (0‐10 cm) in past 24h. 6. Patient provides informed consent. Exclusion criteria: 1. Younger than 18 yr or older than 65 yr. 2. Analgesic taken within the last 8h. 3. History of allergy to NSAIDs, ketamine or local anesthetics. 4. Current use of drugs contraindicated with NSAIDs or ketamine. 5. History of gastrointestinal (GI) disorders, renal or hepatic disease, hemorrhagic disorders, active asthma, poorly controlled diabetes mellitus, cardiovascular disease, increased ICP, int