Gömülü Alt Üçüncü Molar Diş Çekiminde Levobupivakain ve Artikainin Postoperatif Ağrı Giderme ve Lokal Anestezik Etkinliğinin Karşılaştırılması

Abstract

Amaç: Gömülü üçüncü molar diş cerrahisinde %2 artikain ve %0,5 levobupivakainin postoperatif ağrı kesici ve klinik anestezik etkinliğinin karşılaştırılması.

Materyal-Metot: Çalışmaya çift taraflı gömülü üçüncü büyük azı dişleri olan 53 hasta dahil edildi.
Çift kör tekniği ile uygulanan çapraz randomize çalışmada, iki ayrı randevuda bir tarafta levobupivakain (Chirocaine %0.5), diğer tarafta artikain (Ultracaine %2) kullanılarak operasyon gerçekleştirildi. Her iki anestezik ilaç da vazokonstrüktör madde içermedi. anestezik ajanın etkisinin başlama süresi, operasyon süresi, operasyon sırasında kanama miktarı, hemodinamik parametreler, postoperatif analjezi ve anestezi süresi değerlendirildi. Hastadan postoperatif görsel ağrı değerlendirme skalası (VAS) ile ağrı derecesini işaretlemesi istendi.

Bulgular: Articaine ile Anestezinin başlama süresi (80.28 ± 19.27 sn.) levobupivakaine kıyasla (136.69 ± 33.52 sn.) önemli ölçüde daha kısaydı. Levobupivakain ve artikain için ortalama postoperatif anestezi süresi sırasıyla 8 saat ve 3 saat idi (p = 0.000). Levobupivakain ve artikain için ortalama postoperatif analjezi süresi sırasıyla 7-8 saat ve 3 saat idi (p = 0.000). Ayrıca levobupivakain ile postoperatif görsel ağrı skala skorları postoperatif 4. saate kadar artikainden anlamlı derecede düşüktü. Levobupivakain ile yapılan ameliyatlarda belirgin olarak daha az kanama görüldü.

Sonuç: %0.5 Levobupivakain, %2 artikaine kıyasla daha uzun postoperatif anestezi ve analjezi süresi, daha uzun anestezi başlangıcı ve daha az postoperatif ağrı ile sonuçlandı.

Keywords

• Levobupivacaine
• Articaine
• Üçüncü molar cerrahisi
• VAS

A Comparison of the Postoperative Pain Relief and Clinical Local Anesthetic Efficacy of Levobupivacaine and Articaine for Impacted Lower Third Molar Removal

Abstract

Objective: A comparison of postoperative pain relief and clinical anesthetic efficacy of 2% articaine and 0.5% levobupivacaine in impacted third molar dental surgery.

Material-Method: Fifty-three patients underwent the removal of symmetrically positioned lower third molars in 2 separate appointments under local anesthesia either with 2% articaine or 0.5% levobupivacaine in a double-blinded, randomized and crossover study. Neither anesthetic agent contained a vasoconstrictor. The time to onset of anesthesia, duration of surgery, intraoperative bleeding, hemodynamic parameters, the duration of postoperative analgesia and anesthesia as well as postoperative visual analogue scale (VAS) scores were evaluated.

Results: The time to onset of anesthesia with articaine (80.28 ± 19.27 seconds) was significantly less compared to levobupivacaine (136.69 ± 33.52 seconds). The average duration of postoperative anesthesia for levobupivacaine and articaine was 8 hours and 3 hours, respectively (p = 0.000). The mean duration of postoperative analgesia for levobupivacaine and articaine was 7-8 hours and 3 hours, respectively (p = 0.000). Additionally, VAS scores with levobupivacaine were significantly lower than articaine up to the 4th postoperative hour. Significantly less bleeding was seen in the surgeries performed with levobupivacaine.

Conclusion: 0.5% Levobupivacaine resulted in a longer period of postoperative anesthesia and analgesia, a longer time to onset of anesthesia, and less postoperative pain compared to 2% articaine.

Keywords

• Levobupivacaine
• Articaine
• Third molar surgery
• VAS

References

1. [1] Adeyemo, W. L. 2006. Do pathologies associated with impacted lower third molars justify prophylactic removal? A critical review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102(4), 448-452.
2. [2] Thakare, A., Bhate, K., Kathariya, R. 2014. Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: prospective, randomized crossover study. Acta Anaesthesiol Taiwan, 52(2), 59-63.
3. [3] Al-Khateeb, T. H., Bataineh, A. B. 2006. Pathology associated with impacted mandibular third molars in a group of Jordanians. J Oral Maxillofac Surg, 64(11), 1598-1602.
4. [4] Aronson, J. K. Articaine. 2006. Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions: Elsevier, Amsterdam, p. 348-9.
5. [5] Aronson, J. K. 2006. Levobupivacaine. Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions: Elsevier Amsterdam, p. 2037-8.
6. [6] Malamed, S. F. 1997. Clinical Action of Specific Agents. Malamed, S. F., Handbook of Local Anesthesia, 4th ed., Mosby, St. Louis.
7. [7] Danielsson, K., Evers, H., Holmlund, A., Kjellman, O., Nordenram, A., Persson, N. E. 1986. Long-acting local anaesthetics in oral surgery. Clinical evaluation of bupivacaine and etidocaine for mandibular nerve block. Int J Oral Maxillofac Surg, 15(2),119-126.
8. [8] Rood, J. P., Coulthard, P., Snowdon, A. T., Gennery, B. A. 2002. Safety and efficacy of levobupivacaine for postoperative pain relief after the surgical removal of impacted third molars: a comparison with lignocaine and adrenaline. Br J Oral Maxillofac Surg, 40(6), 491-496.

9. [9] Ataoglu, H., Oz, G.Y., Candirli, C., Kiziloglu, D. 2008. Routine antibiotic prophylaxis is not necessary during operations to remove third molars. Br J Oral Maxillofac Surg, 46(2), 133-135.
10. [10] Reis, G. E. D. S., Calixto, R. D., Petinati, M. F. P., Souza, J. F., Kuchler, E. C., Costa, D. J. D., Bonotto, D., Rebellato, N. L. B., Scariot, R. 2020. Effect of different factors on patient perception of surgical discomfort in third molar surgery. Braz Oral Res, 35, e007. [11] Pasqualini, D., Cocero, N., Castella, A., Mela, L., Bracco, P. 2005. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg, 34(1), 52-57. [12] Peterson, L.J. 2003. Principles of Management of Impacted Teeth. Ellis, E., Hupp, J.R. and Tucker, M.R. Contemporary Oral and Maxillofacial Surgery, 4th Edition, Mosby, St. Louis, 184-213.
11. [13] Beirne, O.R. 2006. Postoperative oral amoxicillin/clavulanic acid reduces inflammatory complications following extraction of impacted mandibular third molars. J Evid Based Dent Pract, 6(3), 216-217.
12. [14] Benediktsdottir, I. S., Wenzel, A., Petersen, J. K., Hintze, H. 2004. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 97(4), 438-446.
13. [15] Monaco, G., Tavernese, L., Agostini, R., Marchetti, C. 2009. Evaluation of antibiotic prophylaxis in reducing postoperative infection after mandibular third molar extraction in young patients. J Oral Maxillofac Surg, 67(7), 1467-1472.
14. [16] Vree, T. B., Gielen, M. J. 2005. Clinical pharmacology and the use of articaine for local and regional anaesthesia. Best Pract Res Clin Anaesthesiol, 19(2), 293-308.
15. [17] Foster, R. H., Markham, A. 2000. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs, 59(3), 551-579.
16. [18] Gristwood, R. W., Greaves, J. L. 1999. Levobupivacaine: a new safer long acting local anaesthetic agent. Expert Opin Investig Drugs, 8(6), 861-876.
17. [19] Leone, S., Di Cianni, S., Casati, A., Fanelli, G. 2008. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed, 79(2), 92-105.
18. [20] Branco, F.P., Ranali, J., Ambrosano, G.M,. Volpato, M. C. 2006. A double-blind comparison of 0.5% bupivacaine with 1:200,000 epinephrine and 0.5% levobupivacaine with 1:200,000 epinephrine for the inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,101(4), 442-447. [21] Gregorio, L. V., Giglio, F. P., Sakai, V. T,. Modena, K. C., Colombini, B. L., Calvo, A. M., Sipert, C. R., Dionísio, T. J., Lauris, J. R., Faria, F. A,. Trindade Junior. A. S., Santos, C. F. 2008. 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, 106(1), 19-28.
19. [22] Colombini, B .L., Modena, K .C., Calvo, A. M., Sakai, V. T., Giglio, F. P., Dionisio, T. J., Trindade, A. S. Jr., Lauris, J. R., Santos, C. F. 2006. Articaine and mepivacaine efficacy in postoperative analgesia for lower third molar removal: a double-blind, randomized, crossover study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102(2), 169-174.
20. [23] Grossi, G. B., Maiorana, C., Garramone, R. A., Borgonovo, A., Creminelli, L., Santoro, F. 2007. Assessing postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg, 65(5), 901-917.
21. [24] Penarrocha, M., Sanchis, J. M., Saez, U., Gay, C., Bagan, J. V. 2001. Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 92(3), 260-264.
22. [25] Crincoli, V., Di Bisceglie, M.B., Massaro, M., Giuliani, R., Favia, G., Brienza, N. 2009. Postoperative pain relief after surgical removal of impacted third molars: a single-blind, randomized, controlled study to compare levobupivacaine and mepivacaine. J Orofac Pain, 23(4), 325-329.
23. [26] Kakagia, D. D., Fotiadis, S., Tripsiannis, G., Tsoutsos, D. 2007. Postoperative analgesic effect of locally infiltrated levobupivacaine in fleur-de-Lys abdominoplasty. Aesthetic Plast Surg, 31(2), 128-132.
24. [27] Olmedo-Gaya, M. V., Manzano-Moreno, F. J., Munoz-Lopez, J. L., Vallecillo-Capilla, M. F., Reyes-Botella, C. 2018. Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction. Clin Oral Investig, 22(9), 2981-298.
25. [28] Sancho-Puchades, M., Vilchez-Perez, M. A., Valmaseda-Castellon, E., Paredes-Garcia, J., Berini-Aytes, L., Gay-Escoda, C. 2012. Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial. Med Oral Patol Oral Cir Bucal, 17(3), e462-468. [29] Pellicer-Chover, H., Cervera-Ballester, J., Sanchis-Bielsa, J. M., Penarrocha-Diago, M. A., Penarrocha-Diago, M., Garcia-Mira, B. 2013. Comparative split-mouth study of the anesthetic efficacy of 4% articaine versus 0.5% bupivacaine in impacted mandibular third molar extraction. J Clin Exp Dent, 5(2), e66-71.
26. [30] Trullenque-Eriksson, A., Guisado-Moya B. 2011. Comparative study of two local anesthetics in the surgical extraction of mandibular third molars: bupivacaine and articaine. Med Oral Patol Oral Cir Bucal, 16(3), e390-396.
27. [31] Demiraran, Y., Ozturk, O., Guclu, E., Iskender, A., Ergin, M. H., Tokmak, A. 2008. Vasoconstriction and analgesic efficacy of locally infiltrated levobupivacaine for nasal surgery. Anesth Analg, 106(3), 1008-1011, table of contents.
28. [32] Carmichael, F. A., McGowan, D. A. 1992. Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study. Br J Oral Maxillofac Surg, 30(2), 78-82.
29. [33] Bui, C. H., Seldin, E. B., Dodson, T. B. 2003. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg, 61(12), 1379-1389.
30. [34] Dodson, T. B. 1996. Impacted third molar and mandibular angle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 81(3), 264-265.