Abstract
Objective:
To compare the efficacy of different local anesthetics in managing pain during the surgical removal of palatally placed impacted maxillary canines.
Materials and Methods:
A randomized controlled study was conducted on 90 patients requiring surgical removal of palatally impacted maxillary canines. Patients were divided into three groups, each receiving a different local anesthetic: 2% lidocaine with epinephrine (Group A), 4% articaine with epinephrine (Group B), and 0.5% bupivacaine with epinephrine (Group C). Pain levels were assessed intraoperatively and postoperatively using the Visual Analog Scale (VAS).
Results:
Articaine demonstrated superior intraoperative pain control compared to lidocaine and bupivacaine (VAS score: 1.5 ± 0.6 vs. 3.2 ± 0.8 and 2.8 ± 0.7, respectively, P < 0.05). Postoperative pain relief was significantly prolonged in the bupivacaine group (VAS score at 6 hours: 2.1 ± 0.9 vs. 4.5 ± 1.0 for lidocaine and 3.8 ± 0.9 for articaine, P < 0.05). No severe adverse effects were reported in any group.
Conclusion:
Articaine provides superior intraoperative pain control, while bupivacaine offers longer-lasting postoperative analgesia. The choice of anesthetic should depend on the clinical requirements of intraoperative versus postoperative pain management.
KEYWORDS: Articaine, bupivacaine, lidocaine, local anesthetics, pain management, palatally impacted canine
INTRODUCTION
The surgical removal of palatally impacted maxillary canines is a common but challenging procedure in oral and maxillofacial surgery. Effective pain management during and after the procedure is crucial for patient comfort and satisfaction.[1] Local anesthetics, commonly used for this purpose, vary in their efficacy, duration of action, and side effect profiles.
Lidocaine, articaine, and bupivacaine are widely used anesthetic agents, each with unique pharmacological properties. Lidocaine is known for its reliability and safety, articaine for its enhanced diffusion and potency, and bupivacaine for its prolonged action.[2] However, limited research compares these anesthetics specifically in the context of palatal extractions.[3,4,5] This study aims to fill this gap by assessing their relative efficacy in managing pain during the surgical removal of palatally impacted maxillary canines.
MATERIALS AND METHODS
Study design
A randomized controlled trial was conducted at a tertiary care dental hospital over six months. Ethical clearance was obtained from the Institutional Review Board, and informed consent was secured from all participants.
Sample selection
Ninety patients aged 18-40 years, scheduled for the surgical removal of a single palatally impacted maxillary canine, were included. Exclusion criteria were allergies to local anesthetics, systemic conditions contraindicating surgery, or previous surgeries in the maxillary region.
Group allocation
Participants were randomly assigned into three groups (n = 30 each):
Group A: 2% lidocaine with 1:100,000 epinephrine.
Group B: 4% articaine with 1:100,000 epinephrine.
Group C: 0.5% bupivacaine with 1:200,000 epinephrine.
Pain assessment
Pain was evaluated using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst pain). Intraoperative pain was recorded immediately post-surgery, while postoperative pain was assessed at 2, 4, and 6 hours after the procedure.
Statistical analysis
Data were analyzed using SPSS version 25.0. Mean VAS scores were compared between groups using ANOVA, with a significance level set at P < 0.05.
RESULTS
Demographics and baseline characteristics
The demographic profiles of the three groups were comparable, with no significant differences in age, gender distribution, or baseline VAS scores (P > 0.05).
Intraoperative pain scores
The intraoperative pain scores, measured using the Visual Analog Scale (VAS), demonstrated that articaine provided the most effective pain control during surgery. Patients in the articaine group reported significantly lower mean VAS scores (1.5 ± 0.6) compared to lidocaine (3.2 ± 0.8) and bupivacaine (2.8 ± 0.7). These findings suggest that articaine’s superior diffusion and potency make it the preferred choice for achieving optimal anesthetic effect during the surgical removal of palatally impacted maxillary canines [Table 1].
Table 1.
Intraoperative pain scores
| Group | Mean VAS score±SD | P |
|---|---|---|
| Lidocaine | 3.2±0.8 | <0.05 |
| Articaine | 1.5±0.6 | <0.05 |
| Bupivacaine | 2.8±0.7 | <0.05 |
Postoperative pain scores at 6 hours
Postoperative pain scores indicated that bupivacaine provided the longest duration of pain relief, with a mean VAS score of 2.1 ± 0.9 at 6 hours. In comparison, lidocaine and articaine had significantly higher scores of 4.5 ± 1.0 and 3.8 ± 0.9, respectively. This highlights bupivacaine’s utility in extended postoperative analgesia, especially in cases requiring prolonged pain management without additional interventions. Both tables underscore the complementary roles of articaine and bupivacaine in pain control strategies [Table 2].
Table 2.
Postoperative pain scores at 6 h
| Group | Mean VAS score±SD | P |
|---|---|---|
| Lidocaine | 4.5±1.0 | <0.05 |
| Articaine | 3.8±0.9 | <0.05 |
| Bupivacaine | 2.1±0.9 | <0.05 |
DISCUSSION
The findings of this study highlight the nuanced roles of different local anesthetics in pain management for the surgical removal of palatally impacted maxillary canines. Articaine emerged as the most effective anesthetic for intraoperative pain control, while bupivacaine excelled in providing prolonged postoperative analgesia. These outcomes align with previous research but also underscore the importance of tailoring anesthetic choice to the clinical context.[1,2,3]
Intraoperative pain management
Articaine’s superior intraoperative performance can be attributed to its unique pharmacological profile, including higher lipid solubility and enhanced tissue penetration. These properties allow articaine to achieve faster onset and deeper diffusion into the palatal tissues compared to lidocaine and bupivacaine.[4,5] This is particularly beneficial in maxillary surgeries, where effective anesthesia is often challenging due to the dense cortical bone of the palate. Previous studies have reported similar advantages of articaine over other agents in achieving effective anesthesia during oral surgeries.[6] However, it is important to note that while articaine offers superior efficacy, it may not be suitable for all patients due to its relatively short duration of action and potential neurotoxicity at higher doses.[7]
Postoperative pain management
Bupivacaine’s prolonged action made it the most effective agent for managing postoperative pain in this study. Its extended duration of action is primarily due to its high protein-binding capacity and longer half-life, which ensures sustained analgesia for several hours post-surgery.[8] This is particularly valuable in procedures where patients are likely to experience significant discomfort following surgery. The findings are consistent with earlier research that has demonstrated bupivacaine’s efficacy in providing extended postoperative pain relief.[9] However, the delayed onset of bupivacaine may limit its use in cases requiring immediate anesthesia.
Clinical implications
The study underscores the need for a tailored approach to anesthetic selection based on specific clinical scenarios. Articaine is an excellent choice for patients who prioritize minimal intraoperative discomfort, particularly in procedures where rapid and effective anesthesia is critical. On the other hand, bupivacaine is better suited for patients with low pain tolerance or those undergoing more invasive procedures that necessitate prolonged postoperative analgesia.[10] Lidocaine, while effective, was outperformed by both articaine and bupivacaine in terms of intraoperative and postoperative pain control, suggesting it may be less ideal for complex oral surgeries.
Limitations and future directions
The study’s limitations include its single-center design and relatively small sample size, which may limit the generalizability of the findings. Future multi-center trials with larger sample sizes are needed to validate these results. Additionally, this study did not assess patient satisfaction, cost-effectiveness, or the potential for adverse effects, all of which are important factors in clinical decision-making.[11] Including these parameters in future studies could provide a more comprehensive understanding of the comparative efficacy of these anesthetics.
CONCLUSION
Articaine is the most effective local anesthetic for intraoperative pain management during the surgical removal of palatally impacted maxillary canines, while bupivacaine excels in providing prolonged postoperative analgesia. The choice of anesthetic should consider patient-specific factors and clinical requirements.
Conflict of interest
There are no conflicts of interest.
Funding Statement
Nil.
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