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Post-operative pain and patient preference comparisons of 2% lidocaine with epinephrine vs. 0.75% ropivacaine during surgical removal of mandibular wisdom teeth

Mohseni, Sanaz K
http://rave.ohiolink.edu/etdc/view?acc_num=osu1520008298764522

Abstract Details

2018, Master of Science, Ohio State University, Dentistry.
Introduction: It is common practice during surgical removal of wisdom teeth to administer local anesthetics to the surgical site.1 This serves to reduce the required depth of general anesthesia or sedation required during the operation, and to offer postoperative pain control. Lidocaine is the most commonly used local anesthetic for dental procedures.2 Ropivacaine is a longer acting local anesthetic,6 but it is infrequently used in the dental setting. They are both safe and effective, especially in the low doses used in dentistry. This study aims to compare post-operative pain and patient preference in subjects undergoing extraction of two mandibular third molars using 2% lidocaine with 1:100,000 epinephrine or 0.75% ropivacaine. Materials and Methods: All patients received 2mcg/kg of IV fentanyl. Patients requiring moderate sedation received 2mg boluses of IV midazolam as needed. Patients requiring general anesthesia received 2mg/kg of IV propofol, and 1mg/kg of IV succinylcholine if they were intubated. General anesthesia was maintained with either propofol or sevoflurane. Patients then received a 3 mL injection of 2% lidocaine with epinephrine on one mandibular side and 3 mL of 0.75% ropivacaine on the opposite side according to randomly assigned groups. The extractions were performed by the surgeon. The patients’ post-operative pain was scored for each side of the mouth from 0 to 10 (0 being no pain, 10 being the worst pain) in PACU, at 6 hours post-procedure, and the morning after. A preferred side was also recorded at 6 hours post-procedure and the morning after the procedure. Results: The mean pain score in PACU for the lidocaine side was 1.07, and for the ropivacaine side was 1.13. The mean pain score at hour 6 for the lidocaine side was 3.15, and for the ropivacaine side was 2.42. The mean pain score the morning after the procedure for the lidocaine side was 2.73, and for the ropivacaine side was 2.38. There was a significant difference overall in pain scores between the two drugs (p=0.008), but there was no significant difference when comparing the mean pain scores over time (p= 0.340). In terms of patient preference, at hour 6, 17 prefered lidocaine (32%), and 35 prefered ropivacaine (68%). On the morning after, 18 prefered lidocaine (42%), and 25 preferred ropivacaine (58%). At hour 6, the preference for ropivacaine was significant (p= 0.018), but on the following morning it was not (p=0.360). Conclusion: Overall, no significant interaction was found for drug and time (p=0.340), but a highly significant overall effect of drug was found (p=0.008). If ropivacaine could become more readily available for oral surgeons and dentists, it may provide longer surgical site analgesia after the procedure is completed compared to the more routine shorter acting local anesthetic lidocaine. This has potential for increased patient satisfaction, a smoother transition from local analgesia to oral medications, and a decrease in postoperative opioid or NSAID dosage. This project shows that ropivacaine should be considered for outpatient oral surgery procedures.
Bryant Cornelius (Advisor)
Courtney Jatana (Committee Member)
William Johnston (Committee Member)
Hany Emam (Committee Member)
46 p.
Dentistry
Ropivacaine, Local anesthesia, Local anesthetics, Dentistry, Oral surgery, Third molar extractions, Post-operative pain

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Citations

  • Mohseni, S. K. (2018). Post-operative pain and patient preference comparisons of 2% lidocaine with epinephrine vs. 0.75% ropivacaine during surgical removal of mandibular wisdom teeth [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1520008298764522

    APA Style (7th edition)

  • Mohseni, Sanaz. Post-operative pain and patient preference comparisons of 2% lidocaine with epinephrine vs. 0.75% ropivacaine during surgical removal of mandibular wisdom teeth. 2018. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1520008298764522.

    MLA Style (8th edition)

  • Mohseni, Sanaz. "Post-operative pain and patient preference comparisons of 2% lidocaine with epinephrine vs. 0.75% ropivacaine during surgical removal of mandibular wisdom teeth." Master's thesis, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1520008298764522

    Chicago Manual of Style (17th edition)

osu1520008298764522
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This open access ETD is published by The Ohio State University and OhioLINK.