Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction
- 9 Downloads
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.
These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain.
KeywordsArticaine Bupivacaine Postoperative pain Acute pain Third molar surgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
- 5.Ghaeminia H, Perry J, Nienhuijs MEL, Toedtling V, Tummers M, Hoppenreijs TJM, van der Sanden WJM, Mettes TG, Cochrane Oral Health Group (2016) Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev CD003879. https://doi.org/10.1002/14651858.CD003879.pub4
- 14.Gargallo Albiol J, Herráez Vilas JM, BeriniAytés L, Gay Escoda C (1996) Bases de la utilización de la bupivacaína en cirugía e implantología bucal. Av Odontoestomatol 12:43–48Google Scholar
- 18.Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ, Cochrane Pain, Palliative and Supportive Care Group (2009) Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev CD007076. https://doi.org/10.1002/14651858.CD007076.pub2
- 19.Pellicer-Chover H, Cervera-Ballester J, Sanchis-Bielsa JM, Penarrocha-Diago MA, Penarrocha-Diago M, Garcia-Mira B (2013) Comparative split-mouth study of the anesthetic efficacy of 4% articaine versus 0.5% bupivacaine in impacted mandibular third molar extraction. J Clin Exp Dent 5:e66–e71. https://doi.org/10.4317/jced.50869 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Aggarwal V, Singla M, Miglani S (2017) Comparative evaluation of anesthetic efficacy of 2% lidocaine, 4% articaine, and 0.5% bupivacaine on inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized, double-blind clinical trial. J Oral Facial Pain Headache 31:124–128CrossRefPubMedGoogle Scholar