Crincoli Vito, Favia Gianfranco, LImongelli Luisa, Tempesta Angela, Brienza Nicola
1. Interdisciplinary Department of Medicine, University of Bari, Italy.
2. Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy.
Int J Med Sci. 2015 Oct 16;12(11):862-6. doi: 10.7150/ijms.13072. eCollection 2015.
To compare the efficacy of 0.75% ropivacaine with 3% mepivacaine for pain control in the first 24 hours after surgical removal of lower third molars, using a quantitative measurement such as VAS. The secondary objective involved rescue analgesia.
Forty-five patients, 21 females and 24 males, mean age 23,2 ± 3 years, underwent surgical removal of third molars in two separate sessions. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different anesthetic. The second extraction was carried out 1 month later. Parameters evaluated were: onset of anesthesia, duration of surgery, lip numbness, timing of pain appearance and first analgesic intake.
No significant differences about onset of anesthesia, duration of surgical procedures, and timing of first analgesic intake were found. Lower lip numbness, on the other hand, was more prolonged after using ropivacaine (p < 0.0001) and the onset of postoperative pain was more delayed after anesthesia with ropivacaine (p=0.0048). Pain scores at 1 and 2 hours after surgery were 3.5 ± 2.0 and 4.1 ± 1.3 after injection of mepivacaine, and 2.7 ± 2.2 and 2.9 ± 2.4 after ropivacaine (p value =0.006 for both time points). No significant differences in pain score were recorded between the two anesthetics at 12 and 24 hours post surgery.
With the use of ropivacaine, the discomfort caused by prolonged lip numbness is counterbalanced by less postoperative discomfort after surgery. In addition, when compared with other long-acting anesthetics, ropivacaine ensures a safer anesthetic profile for medically complex patients.
使用视觉模拟评分法（VAS）等定量测量方法，比较0.75%罗哌卡因与3%甲哌卡因在下颌第三磨牙拔除术后24小时内控制疼痛的疗效。次要目标是急救镇痛。
45例患者，21例女性和24例男性，平均年龄23.2±3岁，分两次接受第三磨牙拔除手术。采用双侧对照设计，因此每位患者均接受了第一次和第二次手术，每次拔牙使用不同的麻醉剂。第二次拔牙在1个月后进行。评估的参数包括：麻醉起效时间、手术持续时间、唇部麻木、疼痛出现时间和首次镇痛药物摄入时间。
在麻醉起效时间、手术持续时间和首次镇痛药物摄入时间方面未发现显著差异。另一方面，使用罗哌卡因后下唇麻木时间更长（p<0.0001），罗哌卡因麻醉后术后疼痛出现时间更延迟（p=0.0048）。注射甲哌卡因后手术1小时和2小时的疼痛评分分别为3.5±2.0和4.1±1.3，注射罗哌卡因后分别为2.7±2.2和2.9±2.4（两个时间点的p值均为0.006）。术后12小时和24小时两种麻醉剂的疼痛评分无显著差异。
使用罗哌卡因时，术后不适减轻可抵消唇部麻木时间延长带来的不适。此外，与其他长效麻醉剂相比，罗哌卡因可为病情复杂的患者提供更安全的麻醉方案。
