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

Authors:
Norma Patricia Figueroa-Fernández
Norma Patricia Figueroa-Fernández
Norma Patricia Figueroa-Fernández
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Ailed Hernandez at Autonomous University of Baja California
Ailed Hernandez
Angel Josabad Alonso-Castro at Universidad de Guanajuato
Angel Josabad Alonso-Castro
Mario A Isiordia-Espinoza at University of Guadalajara
Mario A Isiordia-Espinoza
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Abstract and Figures

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.
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ORIGINAL ARTICLE
A meta-analysis on the efficacy of the ropivacaine infiltration
in comparison with other dental anesthetics
Norma Patricia Figueroa-Fernández
1
&Ycenna Ailed Hernández-Miramontes
2
&Ángel Josabad Alonso-Castro
3
&
Mario Alberto Isiordia-Espinoza
4
Received: 15 March 2021 /Accepted: 22 April 2021
#The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
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.
Keywords Ropivacaine .Lidocaine .Bupivacaine .Articaine .Dental anesthesia
Introduction
A large number of dental procedures are performed under
dental anesthesia daily [1]. The local anesthetics, a kind of
amino amide molecule, exert its action by blocking sodium
channels and preventing depolarization of nerve cells. Its
adverse and secondary effects mainly affect the nervous and
cardiovascular systems [2,3]. Lidocaine, articaine,
bupivacaine, mepivacaine, and prilocaine are the local anes-
thetics most used in dentistry [4].
Lidocaine is the most widely used local anesthetic in
odontology. It has demonstrated good clinical efficacy in most
dental procedures [5–8]. However, recent studies have shown
that articaine is more effective than lidocaine for buccal sur-
gery [9], as well as to carry out the inferior alveolar nerve
block (IANB) in patients with irreversible pulpitis [4,10].
Local anesthetics can be combined with a
vasoconstrictor—epinephrine or norepinephrine—with the
purpose of increasing the surgical work time [11]. However,
this pharmacological mixture increases the possibility of ad-
verse effects [12,13]. The adverse reactions to local anes-
thetics occur by allergy or overdose mainly [13–17].
Besides, dental anesthetics could contain well-known aller-
gens such as methylparaben and metabisulfite [15,18]. The
main adverse effects related to the local anesthetics are
*Mario Alberto Isiordia-Espinoza
mario.isiordia162@yahoo.com
1
Departamento de Cirugía Oral y Maxilofacial, Facultad de
Odontología, Universidad Autónoma de Baja California,
Mexicali, BC, México
2
Consulta privada, Tepic, Nayarit, México
3
Departamento de Farmacia, División de Ciencias Naturales y
Exactas, Universidad de Guanajuato, Guanajuato, México
4
Instituto de Investigación en Ciencias Médicas, Departamento de
Clínicas, División de Ciencias Biomédicas, Centro Universitario de
los Altos, Universidad de Guadalajara, Av. Rafael Casillas Aceves
No. 1200, Tepatitlán de Morelos, Jalisco, México
https://doi.org/10.1007/s00784-021-03965-x
/ Published online: 28 April 2021
Clinical Oral Investigations (2021) 25:6779–6790
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The influence of the weight of each study on the results of the meta-analysis was evaluated through a sensitivity study. A p-value of ≤0.05 and odds ratio or a mean difference ≥ 1 (a positive or negative value on a two-sided test) within a 95% confidence interval was considered to be a statistically significant difference [29,30,[32][33][34][35]. ...
... The main advantages of this study include an adequate methodology, rigorous and conservative statistical methods, and the available evidence with a lower risk of bias to perform a powerful pooled analysis [29,30,[32][33][34][35]49]. Local administration of dexamethasone was performed via the submucosal, supraperiosteal, or intraligamentary routes, and different doses of dexamethasone were used. ...
Dexamethasone Increases the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis
Article
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  • Jul 2022
Inferior alveolar nerve block (IANB) has a high failure rate in subjects with symptomatic irreversible pulpitis (SIP). It has been suggested that drugs with anti-inflammatory activity could improve the efficacy of the anesthetic used for IANB. The aim of this study was to assess the effect of dexamethasone on the success of dental anesthesia in patients with SIP. An information search was performed using PubMed and Google Scholar. The risk of bias of the included studies was evaluated with the Cochrane Collaboration’s risk-of-bias tool. The anesthetic success rate, pain intensity (VAS), and adverse effects were extracted. Data were analyzed using the Mantel–Haenszel test and odds ratio or the inverse variance and standardized mean difference. Dexamethasone increased the anesthetic success in comparison with placebo (n = 502; p < 0.001; OR = 2.59; 95% CIs: 1.46 to 4.59). Moreover, patients who were given dexamethasone had lower pain scores at 6 h (n = 302; p < 0.001; MD= −1.43; 95% CIs: −2.28 to −0.58), 12 h (n = 302; p < 0.0001; MD = −1.65; 95% CIs: −2.39 to −0.92), and 24 h (n = 302; p < 0.0008; MD = −1.27; 95% CIs: −2.01 to −0.53) when compared with placebo. In conclusion, the systemic administration of dexamethasone increases the anesthetic success rate and improves pain management in patients with SIP.
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... Furthermore, the funnel plots were employed to assess the publication bias of the included clinical studies. A p-value ≤ of 5% (0.05), with an OR ≥ 1 within a 95% confidence interval (CIs), was considered a statistical difference [32,[35][36][37][38]. ...
Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis
Article
Full-text available
  • Sep 2022
Symptomatic irreversible pulpitis is a painful clinical condition with a broad inflammatory component. Dental anesthesia in these patients is affected by the inflammatory process, reporting a high incidence of anesthesia failure. The aim of this systematic review and meta-analytical evaluation was to determine the effect of pre-treatment with tramadol in patients with symptomatic irreversible pulpitis, as well as for pain control and adverse effects. This study was registered in PROSPERO (ID: CRD42021279262). PubMed was consulted to identify clinical investigations comparing tramadol and placebo/local anesthetics in patients with symptomatic irreversible pulpitis. Data about the anesthesia, pain control, and adverse effects were extracted. Both the anesthetic success index and the adverse effects of local tramadol and placebo were compared with the Mantel–Haenszel test and odds ratio. Data analysis showed that the local administration of tramadol increased the anesthetic success rate when compared to placebo in patients with symptomatic irreversible pulpitis (n = 228; I2 = 0; OR = 2.2; 95% CIs: 1.30 to 3.79; p < 0.004). However, local administration of tramadol increased the risk of adverse effects when compared to placebo/local anesthetics (n = 288; I2 = 0; OR = 7.72; 95% CIs: 1.37 to 43.46; p < 0.02). In conclusion, this study shows that the local administration of tramadol increases the anesthetic success index when compared to placebo in patients with symptomatic irreversible pulpitis.
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... In this study, ropivacaine was used as a local anesthetic, mainly on the basis of ropivacaine's advantages of sensory and motor nerve separation and less influence on postoperative movement, and compared with other local anesthetics, ropivacaine also has advantages of low cardiac and central toxicity and long acting time [20]. A series of studies have shown that its analgesic effect in ophthalmic surgery, dental surgery, and obstetrical and gynecological surgery is superior to that of other anesthetic drugs [21][22][23][24]. Ketorolac is a nonsteroidal anti-inflammatory and analgesic drug that can exert analgesic effects by inhibiting the production of inflammatory pain-causing transmitters. ...
The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty
Article
Full-text available
  • Jul 2022
Objective: This study was conducted to compare postoperative pain and functional recovery in bilateral unicompartmental knee arthroplasty (UKA) and unilateral UKA after cocktail therapy. Methods: A total of 240 patients who received unilateral UKA and bilateral UKA in our orthopedic department from February 2019 to April 2020 were collected. The general clinical data was recorded and compared between the two groups of subjects, and the time of postoperative landing was recorded separately for both groups. A visual analogue scale (VAS) was used to record the patients' pain at 1, 7, and 14 days postoperatively, as well as the range of motion of the affected limb at 1, 7, 14 days, and 3 months postoperatively and the hospital for special surgery (HSS) knee score of the knee at 1 month postoperatively. Results: After cocktail injection analgesia, unilateral patients with knee surgery got off the ground and walked significantly earlier than patients with bilateral surgery, while there was no significant difference between the two groups in terms of pain at 1, 7, and 14 days after surgery, range of motion of the affected limb at 1, 7, 14 days, and 3 months after surgery, and knee HSS score at 1 month after surgery. Conclusion: Periarticular cocktail injection significantly reduces postoperative pain in patients, and bilateral UKA surgery can be used as satisfactory as unilateral UKA in clinical practice.
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Ropivacaine as the drug of choice for regional anesthesia: why so?
Article
Full-text available
  • Aug 2021
While writing the article, we analyzed all the studies related to ropivacaine for the first half of 2021, which were published in PubMed. Previous review articles on ropivacaine were also analyzed. Purpose: collection and analysis of the latest research results on ropivacaine. Assessment of the place of ropivacaine in modern regional anesthesia.
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Dar MM et al use of two different anesthetic solutions Original Research Assessment of efficacy of two different local anesthetic solutions in patients undergoing dental extractions
Article
Full-text available
  • Feb 2023
Background: Painless tooth extraction using the local anesthetic agent is the requirement for the comfort of the patient. The present study was conducted to assess the efficacy of ropivacaine and lignocaine with adrenaline in dental extractions. Materials & Methods: The present study was conducted on 148 patients of both genders. Patients were divided into 2 groups of 74 each. Group I received 0.75% ropivacaine while group II received 2% lidocaine with 1:200,000 adrenaline. Pain on injection, onset of anesthesia, pain during the extraction and duration of anesthesia was assessed and compared in both groups. Results: Mean onset of anesthesia in group I was 7.02 minutes and in group II was 9.52 minutes. The difference was significant (P< 0.05). Duration of anesthesia in group I was 3.24 hours and in group II was 3.68 hours, Pain on injection was 0.94 and 1.28 in group I and II respectively. VAS during procedure was 1.84 in group I and 1.32 in group II. The difference was non-significant (P>0.05). Conclusion: Both solutions found to be equally efficacious in dental extraction cases.
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Selection of analgesics for the management of acute and postoperative dental pain: a mini-review
Article
Full-text available
  • Mar 2020
Pain management is an important part of dental practice, and dentists frequently prescribe analgesics to improve clinical outcomes. Dentists should be aware of the pharmacological characteristics of the analgesics commonly used in dentistry and should choose appropriate analgesics to treat and prevent pain associated with inflammation or surgery. In this article, we review the potential benefits and risks of the analgesics frequently used in dental practice and provide a stepwise approach for pain management.
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The pharmacological management of dental pain
Article
Full-text available
  • Feb 2020
Introduction: Dental pain is primarily treated by dentists and emergency medicine clinicians and may occur because of insult to the tooth or oral surgery. The dental impaction pain model (DIPM) has been widely used in clinical studies of analgesic agents and is generalizable to many other forms of pain. Areas Covered: The authors discuss the DIPM, which has allowed for important head-to-head studies of analgesic agents, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations. Postsurgical dental pain follows a predictable trajectory over the course of one to 3 days. Dental pain may have odontic origin or may be referred pain from other areas of the body. Expert opinion: Pain following oral surgery has sometimes been treated with longer-than-necessary courses of opioid therapy. Postsurgical dental pain may be moderate to severe but typically resolves in a day or two after the extraction. Opioid monotherapy, rarely used in dentistry but combination therapy (opioid plus acetaminophen or an NSAID), was sometimes used as well as nonopioid analgesic monotherapy. The dental impaction pain model has been valuable in the study of analgesics but does not address all painful conditions, for example, pain with a neuropathic component.
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Comparing the anaesthetic efficacy of articaine with lidocaine in patients with irreversible pulpitis: An umbrella review
Article
Full-text available
  • Sep 2019
Background: Pain management can be challenging during root canal treatment of teeth with irreversible pulpitis. Aim: To identify whether articaine or lidocaine is the most appropriate local anaesthetic solution for teeth with irreversible pulpitis undergoing root canal treatment. Data source: The protocol of this umbrella review is registered in the PROSPERO database (CRD42019137624). PubMed, EBSCHO host and Scopus databases were searched until June 2019. Study eligibility criteria, participants, and interventions: Systematic reviews published in English comparing the effectiveness of local anaesthesia following administration of articaine or lidocaine in patients undergoing root canal treatment of teeth diagnosed with irreversible pulpitis were included. Two independent reviewers selected the studies, carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer. Study appraisal and synthesis methods: The quality of the included reviews was appraised by two independent reviewers using the AMSTAR tool (A measurement tool to assess systematic reviews). Each of the 11 AMSTAR items, was given a score of 1 if the specific criterion was met, or 0 if the criterion was not met or the information was unclear. Results: Five systematic reviews with meta-analyses were included. The AMSTAR score for the reviews ranged from 8-11, out of a maximum score of 11, and all reviews were categorized as "high" quality. Two reviews scored 0 for item 8 in AMSTAR because the scientific quality of the clinical trials included in these reviews was not used in the formulation of the conclusions. Limitations: Systematic reviews published only in English language were included. Only a small number of studies were available to assess pain intensity during the injection phase, the time until the onset of anaesthesia and the occurrence of adverse events. Conclusions and implications of key findings: Articaine is more effective than lidocaine for local anaesthesia of teeth with irreversible pulpitis undergoing root canal treatment. There is limited evidence that injection of articaine is less painful, has more rapid onset and has fewer adverse events compared with lidocaine. This article is protected by copyright. All rights reserved.
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CONSORT 2010 statement: Extension to randomised crossover trials
Article
Full-text available
  • Jul 2019
Evidence shows the quality of reporting of randomised controlled trials is not optimal. The lack of transparent reporting impedes readers from judging the reliability and validity of trial findings, prevents researchers from extracting information for systematic reviews, and results in research waste. The Consolidated Standards of Reporting Trials (CONSORT) statement was developed to improve the reporting of randomised controlled trials. The primary focus of the statement was on parallel group trials with two treatment groups. Crossover trials are a particular type of trial for chronic conditions in which participants are randomised to a sequence of interventions. They are a useful and efficient design because participants act as their own control. However, the reporting of crossover trials has been variable and incomplete, which hinders their use in clinical decision making and by future researchers. We present the CONSORT extension to randomised crossover trials, which aims to facilitate better reporting of crossover trials. The CONSORT 2010 checklist is revised for crossover designs, and introduces a modified flowchart and baseline table to enhance transparency. Examples of good reporting and evidence based rationale for CONSORT crossover checklist items are provided.
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Which is the most suitable local anaesthetic when inferior nerve blocks are used for impacted mandibular third molar extraction? A network meta-analysis
Article
  • May 2020
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.
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Different anesthetics on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis
Article
  • Dec 2019
  • J AM DENT ASSOC
Background: The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis. Types of studies reviewed: The authors conducted a search of MEDLINE databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Brazilian Library of Dentistry). There was no restriction on publication year or idiom. The gray literature was also explored. The authors included only randomized clinical trials that compared different anesthetics in the efficacy of IANB in patients with irreversible pulpitis. The risk of bias was evaluated by using the Cochrane Collaboration's tool. A random-effects Bayesian mixed treatment comparison model was used to compare different anesthetic solutions in randomized clinical trials with low or unclear risk of bias. Heterogeneity was assessed by using Cochran Q test and I2 statistics. Quality of evidence was assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: A total of 7,981 studies were identified; only 16 met the eligibility criteria, and they were all meta-analyzed. A significant difference was observed in the pair lidocaine versus articaine, with higher success with articaine (risk ratio, 0.76; 95% confidence interval, 0.63 to 0.88) in the mixed treatment comparison analysis, as this comparison was graded as high-quality evidence. The probability of success for each treatment was 73% for articaine, 57% for prilocaine, 55% for mepivacaine, 53% for bupivacaine, and 12% for lidocaine. This ranking was considered high quality of evidence. Conclusions and practical implications: The use of articaine can increase the IANB success rate in patients with irreversible pulpitis. Among the anesthetic solutions, lidocaine was the least effective.
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Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta-analysis
Article
  • Dec 2019
Background: Spinal anaesthesia has been implicated as one of the possible causes of neurological complications following surgical procedures. This painful condition, occurring during the immediate postoperative period, is termed transient neurological symptoms (TNS) and is typically observed after the use of spinal lidocaine. Alternatives to lidocaine that can provide high-quality anaesthesia without TNS development are needed. This review was originally published in 2005, and last updated in 2009. Objectives: To determine the frequency of TNS after spinal anaesthesia with lidocaine and compare it with other types of local anaesthetics by performing a meta-analysis for all pair-wise comparisons, and conducting network meta-analysis (NMA) to rank interventions. Search methods: We searched CENTRAL, MEDLINE, Elsevier Embase, and LILACS on 25 November 2018. We searched clinical trial registries and handsearched the reference lists of trials and review articles. Selection criteria: We included randomized and quasi-randomized controlled trials comparing the frequency of TNS after spinal anaesthesia with lidocaine to other local anaesthetics. Studies had to have two or more arms that used distinct local anaesthetics (irrespective of the concentration and baricity of the solution) for spinal anaesthesia in preparation for surgery. We included adults who received spinal anaesthesia and considered all pregnant participants as a subgroup. The follow-up period for TNS was at least 24 hours. Data collection and analysis: Four review authors independently assessed studies for inclusion. Three review authors independently evaluated the quality of the relevant studies and extracted the data from the included studies. We performed meta-analysis for all pair-wise comparisons of local anaesthetics, as well as NMA. We used an inverse variance weighting for summary statistics and a random-effects model as we expected methodological and clinical heterogeneity across the included studies resulting in varying effect sizes between studies of pair-wise comparisons. The NMA used all included studies based on a graph theoretical approach within a frequentist framework. Finally, we ranked the competing treatments by P scores. Main results: The analysis included 24 trials reporting on 2226 participants of whom 239 developed TNS. Two studies are awaiting classification and one is ongoing. Included studies mostly had unclear to high risk of bias. The NMA included 24 studies and eight different local anaesthetics; the number of pair-wise comparisons was 32 and the number of different pair-wise comparisons was 11. This analysis showed that, compared to lidocaine, the risk ratio (RR) of TNS was lower for bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine with RRs in the range of 0.10 to 0.23 while 2-chloroprocaine and mepivacaine did not differ in terms of RR of TNS development compared to lidocaine. Pair-wise meta-analysis showed that compared with lidocaine, most local anaesthetics were associated with a reduced risk of TNS development (except 2-chloroprocaine and mepivacaine) (bupivacaine: RR 0.16, 95% confidence interval (CI) 0.09 to 0.28; 12 studies; moderate-quality evidence; 2-chloroprocaine: RR 0.09, 95% CI 0.01 to 1.51; 2 studies; low-quality evidence; levobupivacaine: RR 0.13, 95% CI 0.02 to 0.69; 2 studies; low-quality evidence; mepivacaine: RR 1.01, 95% CI 0.18 to 5.82; 4 studies; very low-quality evidence; prilocaine: RR 0.18, 95% CI 0.07 to 0.49; 4 studies; moderate-quality evidence; procaine: RR 0.14, 95% CI 0.04 to 0.52; 2 studies; moderate-quality evidence; ropivacaine: RR 0.10, 95% CI 0.01 to 0.78; 2 studies; low-quality evidence). We were unable to perform any of our planned subgroup analyses due to the low number of TNS events. Authors' conclusions: Results from both NMA and pair-wise meta-analysis indicate that the risk of developing TNS after spinal anaesthesia is lower when bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine are used compared to lidocaine. The use of 2-chloroprocaine and mepivacaine had a similar risk to lidocaine in terms of TNS development after spinal anaesthesia. Patients should be informed of TNS as a possible adverse effect of local anaesthesia with lidocaine and the choice of anaesthetic agent should be based on the specific clinical context and parameters such as the expected duration of the procedure and the quality of anaesthesia. Due to the very low- to moderate-quality evidence (GRADE), future research efforts in this field are required to assess alternatives to lidocaine that would be able to provide high-quality anaesthesia without TNS development. The two studies awaiting classification and one ongoing study may alter the conclusions of the review once assessed.
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A Randomized Anesthethic Potency Comparison Between Ropivacaine And Bupivacaine On The Perioperative Regional Anesthesia In Lower Third Molar Surgery
Article
  • Jul 2019
  • J CRANIO MAXILL SURG
Background: Perioperative pain control by means of local anesthesia is an intrinsic part of surgical practice. Aim: To evaluate the anesthetic potencies between ropivacaine and bupivacaine in the surgery of mandibular horizontally impacted teeth. Material and method: Outpatients of both sexes, in the age range from 18 to 70 yrs. of age (mean age: 26.48 ± 3.66), participated in this clinical study. After mandibular conduction anesthesia of 0.75% ropivacaine in group I, 0.5% bupivacaine in group II, and 2% lidocaine with 1:100000 epinephrine in group III, the following anesthetics variables were measured: quality of anesthesia score (QAS), success rate of local anesthesia (SLA), onset time of anesthesia (OT), duration of anesthesia (DA), intensity of intraoperative pain (IIP) (VAS scale in mm). Blood pressure, and pulse were measured. Results: Ninety patients, divided into three equal groups, were enrolled for the study. Ropivacaine gained statistically significant (p < 0.05) variables: QAS of 1.77 ± 0.68 and IIP was 18.90 ± 6.11 mm (p < 0.05). The SLA of the achieved local anesthesia was 96.6%, 93.3% and, 86.6% for ropivacaine, lidocaine with epinephrine 1:100000, and bupivacaine groups, respectively. OT was 151.50 ± 80.93, 168.27 ± 79.73, and 89.80 ± 27.91 sec, for groups I, II and III, respectively. The DA for ropivacaine was 412.17 ± 110.04 min, while the one for bupivacaine and lidocaine with epinephrine 1:100000 was 376.30 ± 98.51 min., and 216.13 ± 47.69 min., respectively. Hemodynamic parameters were insignificant to cause side effects. Conclusion: 0.75% ropivacaine provided successful local anesthesia in 96.6% of the patients, better quality and onset of anesthesia with the duration of anesthesia of 412.17 ± 110.04 min and lower intraoperative pain than in the case of 0.5% bupivacaine and 2% lidocaine with epinephrine.
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