title: Pain Reduction in Untreated Symptomatic Irreversible Pulpitis Using Liposomal Bupivacaine (Exparel): A Prospective, Randomized, Double-blind Trial.
abstract: BACKGROUND
  In the treatment of patients with symptomatic irreversible pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively. The Food and Drug Administration has approved Exparel only for infiltrations; therefore, the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated, symptomatic irreversible pulpitis.
  
  
  METHODS
  Ninety-five emergency patients received 2% lidocaine with 1:100,000 epinephrine via infiltration or an inferior alveolar nerve block to relieve their initial presenting pain. Patients then randomly received either 4 mL liposomal bupivacaine (13.3 mg/mL) or 4 mL 0.5% bupivacaine with 1:200,000 epinephrine by infiltration. Patients received a diary for the day of the appointment and 3 days postinjection to record soft tissue numbness, pain levels, and analgesic (non-narcotic and narcotic) use.
  
  
  RESULTS
  No significant differences (P < .05) were found between the 2 anesthetic formulations for pain or the use of pain medications. A statistically higher level of soft tissue numbness was found on days 1 to 3 for the liposomal bupivacaine group.
  
  
  CONCLUSIONS
  Although liposomal bupivacaine had some effect on soft tissue anesthesia, it did not reduce pain to manageable clinical levels in patients presenting with untreated, symptomatic irreversible pulpitis.
authors: Division of Endodontics, Private Practice Limited to Endodontics, Beavercreek, Ohio.
authors: Kristy
authors: K
authors: Bultema
authors: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors: Sara
authors: S
authors: Fowler
authors: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors: Melissa
authors: M
authors: Drum
authors: Division of Endodontics, The Ohio State University, Columbus, Ohio. Electronic address: reader.2@osu.edu.
authors: Al
authors: A
authors: Reader
authors: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors: John
authors: J
authors: Nusstein
authors: Division of Biosciences, The Ohio State University, Columbus, Ohio.
authors: Mike
authors: M
authors: Beck
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid; D000766:Anesthesia, Dental / Q000379:methods; D000772:Anesthesia, Local; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004632:Emergency Medical Services; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D007052:Ibuprofen / Q000627:therapeutic use; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008081:Liposomes / Q000008:administration & dosage / Q000627:therapeutic use; D008340:Mandibular Nerve / Q000187:drug effects; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011671:Pulpitis / Q000628:therapy; D012390:Root Canal Therapy / Q000379:methods; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000082:Acetaminophen; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D002045:Bupivacaine; D004837:Epinephrine; D007052:Ibuprofen; D008012:Lidocaine; D008081:Liposomes; D009294:Narcotics; D014662:Vasoconstrictor Agents
keywords: Bupivacaine; irreversible pulpitis; liposomal bupivacaine; symptomatic patients; untreated irreversible pulpitis