Comparative study of analgesia with bupivacaine 0.25% versus 0.5% for third molar removal under general anesthesia

  • Received : 2016.04.09
  • Accepted : 2016.06.06
  • Published : 2016.06.30


Background: The aim of this study was to compare the effectiveness and duration of action of two concentrations of bupivacaine with adrenaline for postoperative pain in patients undergoing surgical removal of four third molars under general anesthesia. Methods: Sixty patients undergoing surgical removal of four wisdom teeth received bupivacaine 0.5% (n = 30) or 0.25% (n = 30). The severity of pain in the immediate recovery period and at 2 and 24 h after surgery was recorded using the visual analogue scale. Differences were assessed by box and whisper plot and the Student's t-test. Results: The analgesic effects of the 0.25% and 0.5% doses were significantly different (P = 0.022) at 30 min after surgery but not after 2 and 24 h. The difference of mean of 0.25% and 0.5% was much higher after 0.5 h but less after 2 and 24 h. Conclusions: Bupivacaine 0.5% was statistically better for pain control during the immediate postoperative period, but there was no significant difference in pain control between the two dose strengths at 2 and 24 h after surgery.



  1. Sancho-Puchades M, Vilchez-perez M, Valmaseda-Castellon E, Paredes-Garcia J, Berini-Aytes L, Gay-Escoda C. Bupivacaine 0.5% versus 4% for the removal of lower third molars. A crossover randomized controlled trial. Med Oral Patol Oral Cir Bucal 2012; 17: e462-8.
  2. Sisk AL. Long-acting local anaesthetics in dentistry. Anaesth Prog 1992; 39: 53-60.
  3. Valpato MC, Ranali J, Groppo FC. Anaesthetic efficacy of bupivacaine solutions in inferior alveolar nerve block. Anaesth Prog 2005; 52: 132-5.[132:AEB]2.0.CO;2
  4. Moore PA. Bupivacaine: A long-standing local anaesthetic for dentistry. Oral Surg Oral Med Oral Pathol 1984; 58: 369-74.
  5. Bouloux GF, Punnia-Moorthy A. Bupivacaine versus lidocaine for third molar surgery: adouble-blind, randomized, crossover study. J Oral Maxillofac Surg 1999; 57: 510-4.
  6. Branco FP, Ranali J, Ambrosano GM, Volpato MC. A double-blind comparison of 0.5% bupivacaine with 1:200,000 epinepherine and 0.5% levobupivacaine with 1: 200,000 epinepherine for the inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endol 2006; 101: 442-7.
  7. Gregorio LV, Giglio FP, Sakai VT, Modena KC, Colombini BL, Calvo AM, et al. Comparison of the clinical anaesthtic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinepherine) for lower third molar removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: 19-28.
  8. Nayyar MS, Yates C. Bupivacaine as pre-emptive analgesia in third molar surgery: randomized controlled trial. Br J Oral Maxllofac Surg 2006; 44: 501-3.
  9. Shyamala M, Ramesh C, Yuvraj V, Suresh V, Sathya-Narayanan R, Balaji TS et al. A comparative study between bupivacaine with adrenaline and carbonated bupivacaine with adrenaline for surgical removal of impacted mandibular third molar. J Maxillofac Oral Surg 2016; 15: 99-105.
  10. Maeda N, Shimomura I, Kishida K., Nishizawa H, Matsuda M, Nagaretani H, et al. Diet-induced insulin resistance in mice lacking adiponectin/ACRP30. Nat Med 2002; 8: 731-7.

Cited by

  1. An in vivo study comparing efficacy of 0.25% and 0.5% bupivacaine in infraorbital nerve block for postoperative analgesia vol.19, pp.4, 2016,
  2. The Effect of Single-Dose Bupivacaine on Postoperative Iliac Crest Graft Donor Site Pain vol.26, pp.2, 2016,
  3. Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain vol.134, pp.2, 2016,