A randomized anesthethic potency comparison between ropivacaine and bupivacaine on the perioperative regional anesthesia in lower third molar surgery

Abstract

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.

Keywords: Analgesia; Bupivacaine; Impacted lower molars; Local anesthesia; Pain; Ropivacaine.