Comparative study of analgesia with bupivacaine 0.25% versus 0.5% for third molar removal under general anesthesia

Abstract

Background: The aim of this study was to compare the effectiveness and duration of action of two concentrations of bupivacaine with adrenaline for postoperative pain in patients undergoing surgical removal of four third molars under general anesthesia.

Methods: Sixty patients undergoing surgical removal of four wisdom teeth received bupivacaine 0.5% (n = 30) or 0.25% (n = 30). The severity of pain in the immediate recovery period and at 2 and 24 h after surgery was recorded using the visual analogue scale. Differences were assessed by box and whisper plot and the Student's t-test.

Results: The analgesic effects of the 0.25% and 0.5% doses were significantly different (P = 0.022) at 30 min after surgery but not after 2 and 24 h. The difference of mean of 0.25% and 0.5% was much higher after 0.5 h but less after 2 and 24 h.

Conclusions: Bupivacaine 0.5% was statistically better for pain control during the immediate postoperative period, but there was no significant difference in pain control between the two dose strengths at 2 and 24 h after surgery.

Keywords: Bupivacaine; Extraction; Local anesthesia; Third molars.

Fig. 1. Box and whisker plot (bupivacaine 0.25% on left, bupivacaine 0.5% on right). Abbreviation: VAS, visual analogue scale.

Fig. 2. Mean VAS pain scores for bupivacaine 0.25% and bupivacaine 0.5% at 0.5, 2 and 24 h after surgery. Abbreviation: VAS, visual analogue scale.