Oral and maxillofacial surgery
A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal

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Objective

This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal.

Study design

Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated.

Results

A statistically significant difference between the time to onset of A200 (1.66 ± 0.13 minutes) and B200 (2.51 ± 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% ± 3.00% and 88.57% ± 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05).

Conclusions

In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.

Section snippets

Material and Methods

The institutional Ethics Committee approved the protocol and the informed consent document of this study (#75/2006). All patients provided written informed consent during the pretreatment screening period before any study procedures were performed.

The study population comprised 50 patients aged 18 years or over, with both lower third molars in similar positions, as observed in panoramic radiographies. All the subjects were in good health, and none was taking any medication that would alter pain

Results

The study comprised 50 healthy volunteers (21 males and 29 females), with a mean age of 21.84 ± 0.65 years (range 18 to 35), who were divided into 2 categories: surgeries requiring osteotomy (28 patients), and surgeries not requiring osteotomy (22 patients). Hence, all the results except time to onset are expressed according to these 2 categories.

A statistically significant difference between the time to onset of A200 (1.66 ± 0.13 minutes) and B200 (2.51 ± 0.21 minutes) was found (P < .05).

The

Discussion

The present study compares the clinical properties of 2 local anesthetics, 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine. Our results suggest that A200 may be a more desirable local anesthetic to use in some patients compared with B200 because of its shorter time to onset, its shorter duration of soft tissue anesthesia, and comparable intraoperative bleeding control and postoperative analgesic effects as well as possibly somewhat better pain control during the

Conclusion

In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset, and comparable hemostasis and postoperative pain control, with a shorter duration of soft tissue anesthesia in lower third molar removal. Fewer patients required supplemental intraoperative injections when operated with 4% articaine.

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    L.V.L.G. was a recipient of a CNPq fellowship (process #113395/2006-0). The authors thank Vera Lúcia Rufino Rosa for her excellent secretarial assistance. They also thank Dixtal Biomédica Ind e Com Ltda (Marília/SP, Brazil) for kindly providing the DX2010 monitoring system.

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