Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1:80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?

Purpose: We aim to compare and evaluate the anesthetic efficacy and safety of inferior alveolar nerve block (IANB) using 0.75% ropivacaine and 2% lignocaine with 1:80,000 epinephrine in lower impacted third molar (LI3M) surgery.

Patients And Method: We designed a prospective randomized, double-blind, split-mouth study evaluating 60 systemically healthy patients with the presence of bilateral symmetrically oriented LI3M. The sides and sequence of drug administered were randomly allocated. The primary outcome variables analyzed were hemodynamic stability, profoundness of anesthesia, and duration of postoperative analgesia. Time of onset, duration of soft tissue anesthesia, patients requiring analgesics, and their quantity for five postoperative days were recorded.

Results: Early onset of anesthesia was seen in Lignocaine (68.6 ± 20.4 s) compared with Ropivacaine (104.1 ± 17.7 s) with significant differences (p = 0.001). Both the anesthetic solutions were found to be equipotent in providing profound intraoperative anesthesia. No significant difference emerged in perioperative hemodynamic stability. Ropivacaine exhibited statistically significant differences in the duration of soft tissue anesthesia (p = 0.001) and postoperative analgesia (p = 0.001). Patients requiring rescue pain medication and the number of analgesics consumed were greater on first and during five postoperative days in lignocaine when compared with that of ropivacaine with significant differences p < 0.001 and p < 0.001 respectively.

Conclusion: The results suggest that 0.75% ropivacaine is effective in providing adequate anesthesia, prolonged postoperative analgesia, and better postoperative pain control with a safer cardiovascular profile in LI3M surgery. It can be an addition to the existing list of long-acting local anesthetics used for LI3M surgery.