Comparison of bupivacaine and lidocaine use for postoperative pain control in endodontics

Saeed Moradi, Neda Naghavi, Saeed Moradi, Neda Naghavi

Abstract

Introduction: Many patients suffer from mild, moderate or severe pain during or after root canal therapy. Theoretically, post-operative pain control can be achieved by using long-acting local anesthetics. The aim of this study was to evaluate the efficacy of a long acting anesthesia, bupivacaine, on preventing post-operative pain associated with endodontic treatment, and to compare it with lidocaine.

Materials and methods: This study was a double blind and randomized clinical trial on 30 patients' anterior maxillary teeth. The patients were divided into two groups of fifteen. One group was administered lidocanine (2% with 1:100000 epinephrine) local anesthesia and the other group was given bupivacaine (0.5% without epinephrine). The pain in patients were compared using the visual analogue scale (VAS) at definite times i.e. before treatment, during treatment and 2,4,6,8,10,12,24,36 and 48 hours after operation. Data were analyzed using One-way ANOVA tests.

Results: Bupivacaine significantly decreased postoperative pain compared to lidocaine. Postoperative pain was directly related to preoperative pain. Women reported more pain, though significant difference in postoperative pain report was not found between different ages.

Conclusion: In conclusion, a single dose of bupivacaine 0.5% used in infiltration anesthesia could be more effective in reduction or prevention of post-operative endodontic pain compared with lidocaine.

Keywords: Bupivacaine; Infiltration; Lidocaine; Maxilla; Pain.

Figures

Figure 1
Figure 1
Comparative Visual Analogue Scale in: A) bupivacaine + lidocaine B) patients>40 and

References

    1. Ingle JI, Bakland LK, Baumgartner JC. Mechanism of odontogenic and non-odontogenic pain. In: Gibbs JL, Hargreaves KM, editors. Ingle's Endodontics 6. BC Decker; 2008. p. 376.
    1. Moore PA, Dunsky JL. Bupivacaine anesthesia--a clinical trial for endodontic therapy. Oral Surg Oral Med Oral Pathol. 1983;55:176–9.
    1. Byers MR, Taylor PE, Khayat BG, Kimberly CL. Effects of injury and inflammation on pulpal and periapical nerves. J Endod. 1990;16:78–84.
    1. Wong MK, Jacobsen PL. Reasons for local anesthesia failures. JAmDentAssoc. 1992;123:69–73.
    1. Quinn CL. Injection techniques to anesthetize the difficult tooth. J CalifDentAssoc. 1998;26:665–7.
    1. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics. Endodontic Topics. 2002;1:26–39.
    1. Marshall JG, Walton RE. The effect of intramuscular injection of steroid on posttreatment endodontic pain. J Endod. 1984;10:584–8.
    1. Marković AB, Todorović L. Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:e4–8.
    1. Fisher SE, Frame JW, Rout PG, McEntegart DJ. Factors affecting the onset and severity of pain following the surgical removal of unilateral impacted mandibular third molar teeth. Br Dent J. 1988;164:351–4.
    1. Gregorio LV, Giglio FP, Sakai VT, Modena KC, Colombini BL, Calvo AM, Sipert CR, Dionísio TJ, Lauris JR, Faria FA, Trindade Junior AS, Santos CF. A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:19–28.
    1. Corbett IP, Ramacciato JC, Groppo FC, Meechan JG. A survey of local anaesthetic use among general dental practitioners in the U.K. attending post-graduate courses on pain control. Br Dent J. 2005;199:784–7.
    1. Brunetto PC, Ranali J, Ambrosano GM, de Oliveira PC, Groppo FC, Meechan JG, Volpato MC. Anesthetic efficacy of 3 volumes of lidocaine with epinephrine in maxillary infiltration anesthesia. Anesth Prog. 2008;55:29–34.
    1. Davis WM Jr, Oakley J, Smith E. Comparison of the effectiveness of etidocaine and lidocaine as local anesthetic agents during oral surgery. Anesth Prog. 1984;31:159–64.
    1. Crout RJ, Koraido G, Moore PA. A clinical trial of long-acting local anesthetics for periodontal surgery. Anesth Prog. 1990;37:194–8.
    1. Linden ET, Abrams H, Matheny J, Kaplan AL, Kopczyk RA, Jasper SJ Jr. A comparison of postoperative pain experience following periodontal surgery using two local anesthetic agents. J Periodontol. 1986;57:637–42.
    1. Dunsky JL, Moore PA. Long-acting local anesthetics: a comparison of bupivacaine and etidocaine in endodontics. J Endod. 1984;10:457–60.
    1. Reader A, Nusstein J, Hargreaves KM. Local anesthesia in endodontics. In: Cohen S, Hargreaves KM, editors. Pathways of the pulp. 9th Edition. St. Louis: CV Mosby; 2006. p. 700.
    1. Volpato MC, Ranali J, Ramacciato JC, de Oliveira PC, Ambrosano GM, Groppo FC. Anesthetic efficacy of bupivacaine solutions in inferior alveolar nerve block. Anesth Prog. 2005;52:132–5.
    1. Gozal Y, Shapira SC, Gozal D, Magora F. Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand. Acta Anaesthesiol Scand. 1994;38:813–5.
    1. Hyrkäs T, Ylipaavalniemi P, Oikarinen VJ, Paakkari I. Effective postoperative pain prevention through administration of bupivacaine and diclofenac. Anesth Prog. 1994;41:6–10.
    1. Neal JA, Welch TB, Halliday RW. Analysis of the analgesic efficacy and cost-effective use of long-acting local anesthetics in outpatient third molar surgery. Oral Surg Oral Med Oral Pathol. 1993;75:283–5.
    1. Bouloux GF, Punnia-Moorthy A. Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg. 1999;57:510–4.
    1. Fernandez C, Reader A, Beck M, Nusstein J. A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005;31:499–503.
    1. O'Keefe EM. Pain in endodontic therapy: preliminary study. J Endod. 1976;2:315–9.
    1. Yesilsoy C, Koren LZ, Morse DR, Rankow H, Bolanos OR, Furst ML. Post-endodontic obturation pain: a comparative evaluation. Quintessence Int. 1988;19:431–8.
    1. Chapman PJ. A controlled comparison of effectiveness of bupivacaine for post-operative pain control. Aust Dent J. 1988;33:288–90.
    1. Nespeca JA. Clinical trials with bupivacaine in oral surgery. Oral Surg Oral Med Oral Pathol. 1976;42:301–7.
    1. Fox J, Atkinson JS, Dinin AP, Greenfield E, Hechtman E, Reeman CA, Salkind M, Todaro CJ. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol. 1970;30:123–30.
    1. Clem WH. Posttreatment endodontic pain. J Am Dent Assoc. 1970;81:1166–70.
    1. Seltzer S, Bender IB, Ehrenreich J. Incidence and duration of pain following endodontic therapy, Relationship to treatment with sulfonamides and to other factors. Oral Surg Oral Med Oral Pathol. 1961;14:74–82.
    1. Ruetsch YA, Böni T, Borgeat A. From cocaine to ropivacaine: the history of local anesthetic drugs. Curr Top Med Chem. 2001;1:175–82.
    1. Georgopoulou M, Anastassiadis P, Sykaras S. Pain after chemomechanical preparation. Int Endod J. 1986;19:309–14.

Source: PubMed

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