A Comparative Study Between Bupivacaine with Adrenaline and Carbonated Bupivacaine with Adrenaline for Surgical Removal of Impacted Mandibular Third Molar

Abstract

Objectives To compare the effectiveness of bupivacaine with adrenaline with that of carbonated bupivacaine with adrenaline on pain, onset of anesthesia and duration of anesthesia following surgical removal of impacted mandibular third molar. Study design All the patients who underwent surgical removal of impacted mandibular third molar and who fulfilled our inclusion and exclusion criteria from 1st June 2013 to 30th June 2014 were included in our study. Patients who were diagnosed as having impacted mandibular third molar were randomly allocated to two groups namely group A (bupivacaine with adrenaline), group B (carbonated bupivacaine with adrenaline). Pain during deposition of local anesthetic, onset of anesthesia and duration of anesthesia were compared between the two groups. The collected data were subjected to statistical analysis by Chi Square test, Mann-Whitney U test. Results and conclusion The efficacy of carbonated bupivacaine with adrenaline is more compared with bupivacaine with adrenaline in decreasing pain on deposition of local anesthetic solution and in rapid onset of anesthesia. The duration of anesthesia for carbonated bupivacaine with adrenaline and bupivacaine with adrenaline had no significant difference. The use of carbonated bupivacaine with adrenaline will reduce the patient discomfort both intraoperatively and post-operatively.

The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta‐analysis

“…Moreover, all the studies were randomized and double-blinded, except for one study that did not specify blinding (Shyamala et al 2016). Moreover, all the studies were randomized and double-blinded, except for one study that did not specify blinding (Shyamala et al 2016).…”

“…Moreover, all the studies were randomized and double-blinded, except for one study that did not specify blinding (Shyamala et al 2016). Pain was measured on a variety of scales (Table 2), whilst the onset of anaesthesia was assessed by electric pulp testing (Whitcomb et al 2010, Hobeich et al 2013, Shurtz et al 2015 or soft tissue probing (Al-Sultan et al 2006, Kashyap et al 2011, Shyamala et al 2016. Pain was measured on a variety of scales (Table 2), whilst the onset of anaesthesia was assessed by electric pulp testing (Whitcomb et al 2010, Hobeich et al 2013, Shurtz et al 2015 or soft tissue probing (Al-Sultan et al 2006, Kashyap et al 2011, Shyamala et al 2016.…”

“…Lidocaine was used as the anaesthetic agent in 12 studies; bupivacaine was used in one study (Shyamala et al 2016), and articaine was used in one study (Shurtz et al 2015). These two nonlidocaine studies were not pooled in the meta-analysis.…”

“…All of the studies used epinephrine as the vasoconstrictor. The buffered anaesthetic solution was always prepared immediately before injection, manually (Lem 1991, Primosch & Robinson 1996, Al-Sultan et al 2006, Whitcomb et al 2010, Kashyap et al 2011, Phero et al 2017 or using a precision mixing device (Balasco et al 2013, Hobeich et al 2013, Malamed et al 2013, Comerci et al 2015, Harreld et al 2015, Schellenberg et al 2015, Shurtz et al 2015, Shyamala et al 2016. One study was carried out in patients with periapical lesions (Al-Sultan et al 2006); two studies were performed in patients with abscesses (Balasco et al 2013, Harreld et al 2015, and one study was performed in patients with pulpitis (Schellenberg et al 2015).…”

“…Molecules in the cartridge mostly exist in a water-soluble state and are acidic (RNH+). In addition, it is believed that using alkalinized agents, the body takes less time to change the solution from the ionized to the unionized form, increasing nerve penetration and producing rapid onset of the anaesthetic effect (Malamed et al 2013, Shyamala et al 2016. As the physiological pH is about 7.4, an increase in H + in the tissues could cause pain by activating nociceptors such as the acid-sensing ion channels (ASICs) (Cepeda et al 2010, Saatchi et al 2016.…”