Efficacy and safety of bupivacaine versus lidocaine in dental treatments: a meta-analysis of randomised controlled trials

Abstract

The objective of this study was to assess the efficacy and safety of bupivacaine compared with lidocaine in local anaesthesia in dental treatment. Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and the World Health Organisation (WHO) International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand-searched for randomised controlled trials comparing bupivacaine with lidocaine in terms of efficacy and safety. Sixteen studies were included, of which nine had low, six had moderate and one had high risk of bias. In comparison with 2% lidocaine plus 1:100,000 adrenaline, 0.5% bupivacaine plus 1:200,000 adrenaline showed a higher success rate in inflamed pulp (P = 0.03) but a lower success rate in vital pulp (P < 0.00001), a lower percentage of patients using postoperative analgesics (P < 0.00001), a longer onset times of pulpal anaesthesia and a longer duration of pulpal anaesthesia (P < 0.00001). In comparison with 2% lidocaine plus 1:80,000 adrenaline, 0.75% bupivacaine plus 1:200,000 adrenaline had same level of success rate (P = 0.29), and was better in postoperative pain control (P = 0.001) while 0.75% levobupivacaine had same level of postoperative pain control (P = 0.16); 0.5% levobupivacaine had higher success rate (P = 0.04) and was better in postoperative pain control (P = 0.001) than 2% lidocaine. There was no statistically significance in adverse events between two groups. Given the efficacy and safety, the bupivacaine group is better than the lidocaine group in dental operations that take a relatively long time, especially in endodontic treatments or where there is a need for postoperative pain management.

Keywords: Bupivacaine; dentistry; lidocaine; local anesthesia; meta-analysis.

© 2013 FDI World Dental Federation.

Figures

Figure 1.

Flow diagram of study inclusion.

Figure 2.

Meta-analysis comparing 0.5% bupivacaine plus 1:200,000 adrenaline with 2% lidocaine plus 1:100,000 adrenaline in success rate of overall (a), inflamed pulp (b) and vital pulp (c) in local anaesthesia in dentistry.

Figure 3.

Meta-analysis comparing 0.75% bupivacaine plus 1: 200,000 adrenaline with 2% lidocaine plus 1:80,000 adrenaline (a) and 0.5% levobupivacaine with 2% lidocaine (b) in success rate of local anaesthesia in dentistry.

Figure 4.

Meta-analysis in percentage of patients using postoperative analgesic tablets (PPA) in dentistry comparing 0.5% bupivacaine plus 1:200,000 adrenaline with 2% lidocaine plus 1:100,000 adrenaline (a), 0.75% bupivacaine plus 1:200,000 adrenaline with 2% lidocaine plus 1:80,000 adrenaline (b), 0.75% levobupivacaine with 2% lidocaine plus 1:100,000 adrenaline (c) and 0.5% levobupivacaine with 2% lidocaine (d).

Figure 5.

Meta-analysis comparing 0.5% bupivacaine plus 1:200,000 adrenaline with 2% lidocaine plus 1:100,000 adrenaline in onset time of pulpal anesthesia (OTP).

Figure 6.

Meta-analysis comparing 0.5% bupivacaine plus 1: 200,000 adrenaline with 2% lidocaine plus 1:100,000 adrenaline in duration time of pulpal anesthesia (DTP)