Local anaesthetic infiltration for surgical exodontia of third molar teeth: a double-blind study comparing bupivacaine infiltration with i.v. ketorolac

Abstract

We studied 40 patients undergoing surgical removal of at least two third molar teeth under general anaesthesia. Patients were allocated randomly to one of two groups: group B (n = 20) received bupivacaine up to 2 mg kg-1, infiltrated around the inferior alveolar nerves bilaterally, and group K (n = 20) received ketorolac 10 mg i.v. at the start of surgery. There were no significant differences between the two groups in postoperative pain scores measured at 1 h using a visual analogue scale. Group K had a significantly lower incidence of side effects related to intraoral anaesthesia. Swallowing, speech and oral continence were significantly better. Group K scored higher for overall patient satisfaction, measured using a visual analogue scale. We failed to demonstrate any difference in early postoperative recovery (coughing, laryngospasm, stridor or arterial oxygen desaturation) between the groups. We conclude that the use of 0.5% bupivacaine infiltration was no more effective than a single 10-mg injection of ketorolac while giving rise to a higher rate of "minor" airway complications and lower patient acceptability.

Comparative study of two local anesthetics in the surgical extraction of mandibular third molars: Bupivacaine and articaine

“…The longer duration of soft tissue anesthesia of bupivacaine is explained by its higher protein binding and pKa of 8.1 (6). The longer duration of the anesthesia could be unpleasant for patients and could cause difficulty eating, speaking, and a greater risk of soft tissue trauma (11,16,17). The duration of residual analgesia was higher for bupivacaine, although the difference was not statistically significant.…”

Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain

“…However, the use of long-acting intraoral local anesthetic can cause difficulty with speech and swallowing. Many authors consider that these unwanted effects detracts from its usefulness 13,18 . MELLOR et al 18 found no significant difference in analgesia between patients receiving bupivacaine infiltration versus intravenous ketorolac after third molar surgery.…”

“…Many authors consider that these unwanted effects detracts from its usefulness 13,18 . MELLOR et al 18 found no significant difference in analgesia between patients receiving bupivacaine infiltration versus intravenous ketorolac after third molar surgery. However, patients who received ketorolac reported a higher overall patient satisfaction compared with those who received bupivacaine only.…”

Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: Prospective, randomized crossover study

“…The longer duration of the anesthesia could be unpleasant for patients and could cause difficulty eating, speaking, and a greater risk of soft tissue trauma. 18,19 Articaine hydrolyzes rapidly, because it occurs both in plasma and liver. It is rapidly eliminated from the body, but the elimination of bupivacaine takes longer.…”