Local Anesthesia plays a crucial role in Oral and Maxillofacial surgery, ensuring patient comfort during procedures such as tooth extraction and other oral surgical procedures. Lidocaine, an amide type anesthetic , has been the gold standard due to its rapid onset, effectiveness and safety profile. However , alternative anesthetics like tramadol have gained attention for their potential local anesthetic properties , particularly in patients who are allergic to conventional agents.

Tramadol , a centrally acting opioid , has demonstrated local anesthetic properties. Several studies have compared the efficacy of tramadol versus lidocaine for dental procedures. But the mechanism on how it causes anesthetic effect is not fully understood .It has been found that Tramadol with adrenaline can be used as an alternative to lidocaine with adrenaline in terms of onset of anesthesia , duration of anesthesia , pain score via local infiltration technique .There are not enough literature to prove its effect as a nerve block  and for any procedure in mandible .This study evaluates the efficacy of Tramadol hydrochloride with adrenaline for inferior alveolar nerve block for intra alveolar extraction of mandibular posterior teeth