Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial

Abstract

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed.

Study design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests.

Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.5). Systolic blood pressure and heart rate values were significantly higher with articaine.

Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Figure 1

Systolic arterial pressure changes over surgery. (Articaine: blue line, Bupivacaine: green line).

Figure 2

Heart rate changes over surgery. (Articaine: blue line, Bupivacaine: green line).

Figure 3

P values corresponding to differences between visual analogue scale scores with both anesthetic solutions at different times. The blue line corresponds to articaine and the green line to bupivacaine. Differences were statistically significant on day 1 at 2:00 pm and 4:00 pm (shadowed cells).