title: Postoperative pain after bupivacaine supplementation in mandibular third molar surgery: splint-mouth randomized double blind controlled clinical trial.
abstract: BACKGROUND
  Efficacy of anesthetic supplementation with bupivacaine to control both pain and the number of analgesics ingested after surgery has been proposed; however, no report was found in the literature regarding supplemental use of bupivacaine. Thus, the aim of this study was to evaluate the clinical efficacy of bupivacaine in appeasing postoperative pain, when used as supplemental anesthesia at the end of surgeries to extract mandibular third molars.
  
  
  METHODS
  Eighty surgeries were performed in 40 healthy ASA I patients of mandibular bilateral, semi-enclosed, and symmetrical third molars, in a randomized, double-blind, placebo-controlled, and split-mouth clinical trial. Two procedures were performed. In one case, a preoperative anesthetic block was performed with bupivacaine (0.5 %) and epinephrine (1:200,000). Supplementation with the same anesthetic composition was used at the end of the surgery (test group). In the second case (control group), the procedure was identical to that used in the test group, but was supplemented in a randomized double-blind trial with saline (placebo), using the split-mouth method. Postoperative pain (measured with a visual analog scale) was the primary variable studied, and analgesic consumption was the secondary variable. Nonparametric analysis of variance (Wilcoxon test) and a two-tailed test to determine the ratio was used. P value was set at 0.05.
  
  
  RESULTS
  No statistically significant difference (P > 0.05) was found in the variables studied. An adverse effect related to the anesthetic under study was not observed.
  
  
  CONCLUSIONS
  There is no appreciable value to the second injection regarding pain and analgesia use, but there was a difference regarding patient acceptance in surgeries of mandibular semi-enclosed and impacted third molars.
authors.affiliation: Department of Stomatology, Discipline of Integrated Dental Clinic, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Ana Mara Morais
authors.initials: AM
authors.lastname: de Souza
authors.forename: Anna Carolina Ratto Tempestini
authors.initials: AC
authors.lastname: Horliana
authors.forename: José Leonardo
authors.initials: JL
authors.lastname: Simone
authors.forename: Waldyr Antonio
authors.initials: WA
authors.lastname: Jorge
authors.forename: Isabel Peixoto
authors.initials: IP
authors.lastname: Tortamano
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008334:Mandible / Q000601:surgery*; D008964:Molar, Third / Q000601:surgery*; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D010919:Placebos; D014081:Tooth Extraction / Q000379:methods*; D014095:Tooth, Impacted / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D010919:Placebos; D002045:Bupivacaine