Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction

  • Maria Victoria Olmedo-Gaya
  • Francisco Javier Manzano-Moreno
  • Jose Luis Muñoz-López
  • Manuel Francisco Vallecillo-Capilla
  • Candela Reyes-Botella
Original Article



The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction.

Materials and methods

The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18–30 years) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with numbers (1 and 2, respectively). Postoperative pain intensity (primary outcome) was evaluated with a visual analogue scale (VAS), while the requirement for and timing of rescue medication and the quality of intraoperative anesthesia were also measured (secondary outcomes).


VAS-measured pain intensity was significantly higher (p < 0.05) in the articaine group than in the bupivacaine group at all time points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p = 0.252). The groups did not significantly differ (p = 0.391) in the quality of the intraoperative anesthesia.


Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery.

Clinical relevance

These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain.

Trial registration



Articaine Bupivacaine Postoperative pain Acute pain Third molar surgery 



The work was supported by the Master Course of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Spain.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the ethical committee of the University of Granada and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Stomatology, School of DentistryUniversity of GranadaGranadaSpain
  2. 2.Biomedical Group (BIO277)University of GranadaGranadaSpain
  3. 3.Instituto Investigación Biosanitaria, ibs.GranadaGranadaSpain
  4. 4.Master of Oral Surgery and Implant Dentistry, School of DentistryUniversity of GranadaGranadaSpain

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