The Effectiveness of Ropivacaine and Mepivacaine in the Postoperative Pain after Third Lower Molar Surgery

The Comparative Evaluation of the Anesthetic Efficacy of 4% Articaine With 1:100,000 Adrenaline and 0.75% Ropivacaine for Inferior Alveolar Nerve Block in the Extraction of Impacted Lower Third Molar

Introduction

Postoperative pain management is a major concern in lower third molar surgery. Various local anesthetic agents are studied for the same. Articaine and ropivacaine are recently studied for pain control intra- and postoperatively in minor oral surgical procedure. However, there is sparse literature that compares these two agents. Therefore, the present study was designed to compare 4% articaine with 1:100,000 adrenaline and 0.75% ropivacaine for inferior alveolar nerve block in lower impacted third molar surgery.

Materials and method

A prospective, randomized controlled, split-mouth, double-blind study was performed. A total of 60 healthy patients requiring extraction of lower impacted third molar with similar difficulty index were included in the study. Patients were administered 4% articaine with 1:100,000 adrenaline and 0.75% ropivacaine on either side by random allocation. The procedure was performed at an interval of 14 days. Parameters assessed were time of onset of anesthesia, profoundness of anesthesia, hemodynamic parameters (heart rate and blood pressure), duration of soft tissue anesthesia, duration of postoperative analgesia, and postoperative symptom severity (PoSSe) scale.

Results

The time of onset of articaine was faster (69.20 + 20.13 seconds) compared to ropivacaine (104.06 + 17.66 seconds). No significant difference was observed in hemodynamic parameters. There was significant difference in duration of soft tissue anesthesia, postoperative analgesia, and PoSSe scale between the two groups.

Conclusion

Within the limitations of the study, 0.75% ropivacaine was effective in providing prolonged soft tissue anesthesia, postoperative analgesia, and better PoSSe scale with hemodynamic stability compared to 4% articaine.

Effectiveness of dexamethasone or adrenaline with lignocaine 2% for prolonging inferior alveolar nerve block: a randomized controlled trial

Objectives

Inferior alveolar nerve block (IANB) is commonly used for mandibular dentoalveolar surgery. The objective of this study was to evaluate and compare the effectiveness of coadministration of dexamethasone (4 mg/mL) or adrenaline (0.01 mg/mL) as an adjuvant with lignocaine 2% in IANB during third molar surgery (TMS).

Patients and Methods This double-blind, randomized controlled trial was conducted between March and August 2020. The investigators screened patients needing elective TMS under local anesthesia. Based on strict inclusion and exclusion criteria, patients were enrolled in this study. These patients were assigned randomly into two study groups dexamethasone group (DXN) or adrenaline group (ADN). Outcome variables were postoperative edema, trismus, visual analogue scale (VAS), perioperative analgesia, onset time, and duration of IANB.

Results

Eighty-three patients were enrolled in this study, of whom 23 (27.7%) were eliminated or excluded during follow-up. This study thus included data from 60 samples. Mean age was 32.28±11.74 years, including 28 females (46.7%) in the ADN (16 patients, 57.1%) and DXN (12 patients, 42.9%) groups. The duration of action for DXN (mean±standard deviation [SD], 40207±03401 hours; standard error [SE], 00600 hours; log-rank P=0.001) and for ADN (mean±SD, 15834±02452 hours; SE, 00442 hours; log-rank P=0.001) were found. Similarly, time at which 1st analgesic consume and total number of nonsteroidal antiinflammatory drugs need to rescue postoperative analgesia was found statistically significant between study groups (t (58)=–11.95; confidence interval, –22541 to –14353; P=0.001). Early-hours VAS was also significantly different between the study groups.

Conclusion

A single injection of dexamethasone prolongs the duration of action of lignocaine 2% IANB. Additionally, it can be used in cases where adrenaline is contraindicated.

A meta-analysis on the efficacy of the ropivacaine infiltration in comparison with other dental anesthetics

OBJECTIVES

The aim of this meta-analysis was to assess the clinical efficacy and safety profile of ropivacaine in comparison with other dental anesthetics in different clinical conditions. MATERIALS AND METHODS: This meta-analysis was registered in the National Institute for Health Research PROSPERO (ID: CRD42020205580). PubMed and Scholar Google were consulted to identify clinical trials using ropivacaine in comparison with other local anesthetic drugs for any dental procedure. Articles comparing ropivacaine and other dental anesthetics were assessed with the Cochrane Collaboration's risk of bias tool. Data from reports without a high risk of bias were extracted (anesthetic and adverse effects) and analyzed using the Review Manager Software 5.3. for Windows and the Risk Reduction Calculator.

RESULTS

Ropivacaine produces a longer anesthetic time when compared with lidocaine/adrenaline (n = 260; p = 0.00001) and similar anesthesia than bupivacaine (n = 190).

CONCLUSIONS

Data of this study indicate that ropivacaine infiltration produces a longer anesthetic time when compared with lidocaine and articaine but not when compared to bupivacaine in dental procedures.

CLINICAL RELEVANCE

Ropivacaine was more effective than lidocaine for dental anesthesia. For this reason, the manufacture of a ropivacaine dental cartridge with a suitable concentration could be an important advancement for clinical practice.

Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial

Background

Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique.

Methods

This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure.

Results

The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate.

Conclusion

Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

Comparison of anaesthetic efficacy of ropivacaine (0.75% & 0.5%) with 2% lignocaine with adrenaline (1:200000) in surgical extraction of bilateral mandibular 3rd molars using IANB:a prospective, randomized, single blind study

Aim

To evaluate and compare the anaesthetic efficacy of 0.75% ropivacaine and 0.5% ropivacaine with 2% lignocaine with 1:200000 Adrenaline (LWA) for surgical extraction of bilateral mandibular 3rd molars using Direct inferior alveolar nerve block (IANB).

Material and methods

Total of 60 outpatients of both sex,age group of 18-40 included in a prospective, randomized, single blind, split mouth clinical study after satisfying inclusion and exclusion criteria. Group I includes 30 patients and 0.75% ropivacaine as test drug, Group II includes 30 patients and 0.5% ropivacaine as test drug. In both group control drug was LWA.Parameters measured were onset of action, duration of action, systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale (VAS), faces pain scale (FPS).

Result

Onset of action of 0.75%/0.5% ropivacaine (101.84 ​± ​16.92 ​secs/113.03 ​± ​12.77 ​sec) was faster than LWA (Group I-218 ​± ​21.51 ​secs, Group II-196.47 ​± ​26.27 ​secs). Duration of action of 0.75%/0.5% ropivacaine (343.55 ​± ​16.44 ​mins/319.03 ​± ​19.30 ​mins) was longer than 2% Lignocaine with 1:200000 adrenaline (Group I I-173 ​± ​16.86 ​mins, Group II-175.20 ​± ​18.02 ​mins). In Group I - VAS/FPS of 0.75% Ropivacaine (0.97 ​± ​0.54/1.32 ​± ​0.65) was significantly lower as compared to LWA (2.90 ​± ​0.83/3.29 ​± ​0.69). In group II-VAS/FPS of 0.5% ropivacaine (1.40 ​± ​0.72/1.47 ​± ​0.50) was lower as compared to LWA (3.40 ​± ​0.89/3.30 ​± ​0.87). Mean systolic blood pressure, diastolic blood pressure, heart rate was lower for ropivacaine (0.75%, 0.5%) than LWA except mean heart rate higher for 0.75% ropivacaine at 10 ​min after injection. Else mean heart rate lower in other time interval.

Conclusion

Ropivacaine (0.75%,0.5%) was more efficacious than 2% lignocaine with adrenaline (1:200000) it terms of all measured parameters in study.

Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis

OBJECTIVE

To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars.

METHODS

Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The "JBI Critical Appraisal Tools for Systematic Reviews" was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence.

RESULTS

The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = - 1.44; - 2.72 to - 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = - 1.36; - 2.13 to - 0.59). The certainty of evidence varied between very low to moderate.

CONCLUSION

2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars.

CLINICAL SIGNIFICANCE

The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.

Which is the most suitable local anaesthetic when inferior nerve blocks are used for impacted mandibular third molar extraction? A network meta-analysis

The aim of this study was to compare the efficacy and safety of the different local anaesthetic agents for the extraction of impacted lower third molars. A network meta-analysis was performed of all published reports of randomized controlled clinical trials assessing efficacy (anaesthetic success and absence of need for supplementary anaesthesia during the surgical procedure) and/or safety (number of adverse events) of anaesthetic agents. Three electronic databases were searched, from their earliest records up to April 2019. Additionally, the grey literature was searched to identify further potential candidates for inclusion. Anaesthesia had to be delivered by an inferior alveolar nerve block, complemented with infiltration anaesthesia of the buccal nerve. The quality of the studies was assessed using the Cochrane Collaboration tool. This study included a total of 21 trials (2021 molars) assessing the efficacy and 19 trials (1977 molars) assessing the safety of 11 anaesthetic solutions. Seven of the studies included were considered to have a high risk of bias. The most effective local anaesthetic for the extraction of impacted mandibular third molars appeared to be 4% articaine, with significant differences when compared with 2% lidocaine, 0.5% bupivacaine, and 1% ropivacaine. Lidocaine is the safest local anaesthetic, although all investigated solutions can be used safely.

Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1:80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?

PURPOSE

We aim to compare and evaluate the anesthetic efficacy and safety of inferior alveolar nerve block (IANB) using 0.75% ropivacaine and 2% lignocaine with 1:80,000 epinephrine in lower impacted third molar (LI3M) surgery.

PATIENTS AND METHOD

We designed a prospective randomized, double-blind, split-mouth study evaluating 60 systemically healthy patients with the presence of bilateral symmetrically oriented LI3M. The sides and sequence of drug administered were randomly allocated. The primary outcome variables analyzed were hemodynamic stability, profoundness of anesthesia, and duration of postoperative analgesia. Time of onset, duration of soft tissue anesthesia, patients requiring analgesics, and their quantity for five postoperative days were recorded.

RESULTS

Early onset of anesthesia was seen in Lignocaine (68.6 ± 20.4 s) compared with Ropivacaine (104.1 ± 17.7 s) with significant differences (p = 0.001). Both the anesthetic solutions were found to be equipotent in providing profound intraoperative anesthesia. No significant difference emerged in perioperative hemodynamic stability. Ropivacaine exhibited statistically significant differences in the duration of soft tissue anesthesia (p = 0.001) and postoperative analgesia (p = 0.001). Patients requiring rescue pain medication and the number of analgesics consumed were greater on first and during five postoperative days in lignocaine when compared with that of ropivacaine with significant differences p < 0.001 and p < 0.001 respectively.

CONCLUSION

The results suggest that 0.75% ropivacaine is effective in providing adequate anesthesia, prolonged postoperative analgesia, and better postoperative pain control with a safer cardiovascular profile in LI3M surgery. It can be an addition to the existing list of long-acting local anesthetics used for LI3M surgery.

Role of addition of dexamethasone to lignocaine 2% with adrenaline in dental nerve blocks for third molar surgery: A prospective randomized control trial

Context:

Dexamethasone has been frequently used in oral surgical procedure and accepted by oral and maxillofacial surgeon community worldwide. However, this is the first clinical trial that used dexamethasone as adjuvant with lignocaine in dental nerve block (DNB).

Aims:

The purpose of this double-blind, randomized control trial (RCT) was to compare the effect of dexamethasone with normal saline (NS) in a lignocaine DNB.

Settings and Design:

This prospective, double-blind, RCT was carried out after obtaining approval from the Institutional Ethical Committee.

Subjects and Methods:

In forty patients, the present placebo-controlled clinical trial was conducted; allocated randomly into two groups: study group (SG) or control group (CG). The single-dose submucosal dexamethasone or NS injection was administered immediately after 2% lignocaine with epinephrine 1:2,00,000 nerves block during mandibular third molar surgery (TMS). Visual analog scale score, number, and exact time nonsteroidal anti-inflammatory drugs were administered were used to measure postoperative analgesia in 2^nd and 7^th days.

Statistical Analysis Used:

All the data were entered into the Spreadsheet (Excel, Microsoft) and Chi-square test, Mann–Whitney U-test, Student's paired and unpaired t-test, and Fisher exact test were used.

Results:

This study found maximum duration of DNB in SG was 248.88 min and in CG was 175.44 min, whereas minimum duration in SG was 197 min and in CG was 140.78 min.

Conclusions:

Dexamethasone prolongs the action of lignocaine 2% in DNB for TMS.