Efficiency of Bupivacaine Versus Lidocaine and Methylprednisolone Versus Placebo to Reduce Postoperative Pain and Swelling After Surgical Removal of Mandibular Third Molars: A Randomized, Double-Blinded, Crossover Clinical Trial

Purpose: To compare 4 treatment combinations to reduce postoperative pain and swelling after surgical removal of mandibular third molars. Patients and Methods: Patients scheduled for bilateral mandibular third molar removal were randomized to 1 of 4 treatment groups in a double-blinded crossover design: 1) first operation: lidocaine and placebo, second operation: bupivacaine and methylprednisolone; 2) first operation: bupivacaine and methylprednisolone, second operation: lidocaine and placebo; 3) first operation: lidocaine and methylprednisolone, second operation: bupivacaine and placebo; 4) first operation: bupivacaine and placebo, second operation: lidocaine and methylprednisolone. Patient-reported pain and swelling were recorded using visual analog scales 2, 4, 6, 8, and 12 hours after surgery and daily during the first postoperative week. The treatment effects were estimated as contrasts between the average differences within the treatment groups and assessed by stratified t tests. Results: A total of 126 patients (57 women and 69 men; mean age, 25.0 years) were included in the analysis. No significant interactions between local analgesia and methylprednisolone were observed. The administration of bupivacaine resulted in less postoperative pain up to 12 hours after surgery (P < .004) and more postoperative swelling 4 to 12 hours after surgery (P < .001) compared with lidocaine. The administration of methylprednisolone resulted in less postoperative pain 4 to 12 hours and 2 days after surgery (P < .05) and less postoperative swelling 6 and 12 hours and 1 to 3 days after surgery (P < .04) compared with placebo. Conclusions: Bupivacaine combined with methylprednisolone reduced the postoperative pain and swelling compared with the use of lidocaine and placebo, lidocaine and methylprednisolone, or bupivacaine and placebo. (C) 2013 American Association of Oral and Maxillofacial Surgeons