Brajkovic Denis, Brkovic Bozidar, Milic Marija, Biocanin Vladimir, Krsljak Elena, Stojic Dragica
Clinic of Oral Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
Clin Oral Investig. 2014;18(5):1481-8. doi: 10.1007/s00784-013-1114-0. Epub 2013 Oct 6.
The main purpose of this prospective, double-blind, randomized study was to evaluate anaesthetic parameters, postoperative analgesia and vasoactive properties of levobupivacaine and bupivacaine for lower third molar surgery.
Sixty patients (ASA I) were scheduled for lower third molar surgery under inferior alveolar nerve block, lingual nerve block and buccal nerve block (mandibular nerve blocks) obtained with 3 ml of 0.5 % levobupivacaine and 3 ml of 0.5 % bupivacaine. Success rate, onset and duration of three nerve bocks were evaluated by electrical pulp testing, pinprick testing and signs of soft tissue anaesthesia (patient-reported numbness). Intensity of intraoperative anaesthesia and postoperative analgesia were measured with visual analogue scale (VAS) and numeric rating scale (NRS). The time of first postoperative pain reported and analgesic consumption were also recorded. The laser Doppler flowmetry was used for the measurement of the first premolar pulpal blood flow.
There were no differences between levobupivacaine and bupivacaine regarding the success rate, onset and duration of mandibular nerve blocks as well as intensity of postoperative analgesia and analgesic consumption. Intensity of intraoperative anaesthesia and duration of postoperative analgesia were significantly higher in the levobupivacaine than in the bupivacaine group. Both anaesthetics showed similar biphasic vasoactive effect.
Levobupivacaine 0.5 % achieved superiority over bupivacaine 0.5 % in the intensity of intraoperative anaesthesia and duration of postoperative analgesia for lower third molar surgery under the mandibular nerve blocks.
It seems that the plain levobupivacaine (0.5 %) could be an effective alternative to plain bupivacaine (0.5 %) in those dental procedures which require profound bone and soft tissue anaesthesia.
本前瞻性、双盲、随机研究的主要目的是评估左旋布比卡因和布比卡因用于下颌第三磨牙手术的麻醉参数、术后镇痛及血管活性特性。
60例美国麻醉医师协会（ASA）分级为I级的患者计划接受下颌第三磨牙手术，采用3ml 0.5%左旋布比卡因和3ml 0.5%布比卡因进行下牙槽神经阻滞、舌神经阻滞和颊神经阻滞（下颌神经阻滞）。通过牙髓电活力测试、针刺测试和软组织麻醉体征（患者自述麻木）评估三种神经阻滞的成功率、起效时间和持续时间。采用视觉模拟评分法（VAS）和数字评定量表（NRS）测量术中麻醉强度和术后镇痛强度。记录首次报告术后疼痛的时间和镇痛药物消耗量。使用激光多普勒血流仪测量第一前磨牙的牙髓血流。
左旋布比卡因和布比卡因在下颌神经阻滞的成功率、起效时间和持续时间以及术后镇痛强度和镇痛药物消耗量方面无差异。左旋布比卡因组的术中麻醉强度和术后镇痛持续时间显著高于布比卡因组。两种麻醉药均显示出相似的双相血管活性作用。
在下颌神经阻滞下进行下颌第三磨牙手术时，0.5%左旋布比卡因在术中麻醉强度和术后镇痛持续时间方面优于0.5%布比卡因。
在那些需要深度骨和软组织麻醉的牙科手术中，单纯的0.5%左旋布比卡因似乎可以成为单纯0.5%布比卡因的有效替代品。
