Immediate postoperative anesthesia with either lidocaine or bupivacaine: A short-term clinical response

Abstract

Background: The purpose of this randomized, three-armed clinical trial is to determine if a postoperative injection of 0.5% bupivacaine is more effective than 2% lidocaine in controlling pain after periodontal flap surgery.

Methods: Seventy-six patients planned for similar periodontal surgeries were included. Prior to surgery, patients were randomized to receive one cartridge (1.7 mL) of either 2% lidocaine, 0.5% bupivacaine, or 0.9% sodium chloride as a local injection immediately postoperatively. A standardized regimen of 600 mg ibuprofen and 325 mg acetaminophen was used to manage postoperative pain. Patients recorded pain levels on a 21-point numerical rating scale (NRS-21) as well as analgesic usage via a phone application at 4, 8, 12, 24, and 48 h, postoperatively.

Results: While NRS-21 data suggested a consistent trend toward decreased pain with both bupivacaine and lidocaine administration compared with placebo, there were no statistically significant differences in pain response or analgesic usage at any time between the three groups.

Conclusions: This study showed no statistically significant differences in pain or analgesic usage after periodontal flap surgery following postoperative injections with either bupivacaine, lidocaine, or placebo.

Plain language summary: Long-acting local anesthetic, notably bupivacaine, has been given immediately following dental procedures to reduce the amount of postoperative pain and discomfort. This study aimed to study the immediate effects of bupivacaine compared with a shorter acting local anesthetic (lidocaine) and a placebo (0.9% sodium chloride). Seventy-six patients underwent various dental surgeries where reflection of the soft tissue was performed. At the conclusion of surgery, patients were randomized into one of the three groups and the appropriate blinded cartridge of bupivacaine, lidocaine, or placebo was injected into the surgical site. Patients reported their pain on a numeric rating scale from 0-10 (NRS-21) as well as the number of pain medications taken via a phone application at 4, 8, 12, 24, and 48 h after the surgery. Demographic and secondary variables such as amount of anesthetic given and length of surgery were also collected. While NRS-21 data suggested a consistent trend toward decreased pain with both bupivacaine and lidocaine administration compared with placebo, there were no significant differences in pain response or pain medication usage at any time between the three groups.

Keywords: analgesics; anesthetics local; anti‐inflammatory; bupivacaine; lidocaine; pain; pain scale; postoperative.