A randomized clinical trial comparing 0.75% ropivacaine and 2% lidocaine with 1:200,000 adrenaline in minor oral surgery

Background and Objectives: Ropivacaine is used uncommonly in dentistry in India despite its long duration of action, vasoconstriction, selectiveness for pain fibres and less cardiovascular toxicity. The present split-mouth study compared the clinical efficacy and cardiovascular toxicity of 0.75% ropivacaine (test arm) to 2% lignocaine with 1:200000 adrenaline (control arm) in third molar and orthodonti cextractions.
Methods: In this prospective, double-blind, randomized clinical trial, 105 patients were allocated to 3 groups. Group 1 required extraction of bilateral (B/L) maxillary premolars, group 2 of B/L mandibular premolars, and group 3 of B/L mandibular third molars having a comparative difficulty index. The choice of first local anaesthetic (LA) and first extraction was randomized and the same procedure was performed two weeks later with other LA on the opposite side. Intra-operatively, the onset of anaesthesia and analgesia, systolic and diastolic blood pressures (SBP, DBP), heart rate (HR), electrocardiogram (ECG) changes, and visual analogue scale (VAS) pain scores were recorded. Postoperatively, duration of anesthesia and analgesia were obtained.
Results: The onset of anaesthesia and analgesia were significantly slower with ropivacaine. The duration of anaesthesia in all three groups was significantly longer with ropivacaine(p value= 0.000). Duration of analgesia was significantly longer with ropivacaine in group 3 only (p value= 0.000). Mostly insignificant statistical difference was found with respect to SBP, DBP, HR and VAS pain score in all groups.
Conclusion: Ropivacaine, with a significantly longer duration of anesthesia and postoperative analgesia, is beneficial in minor oral surgical procedures.