Abstract

Objective: This study was conducted to compare the anesthetic and analgesic efficacy of bupivacaine with other local anesthetic agents routinely used for mandibular third molar surgery. Method and materials: Four electronic databases (PubMed, Scopus, Cochrane, and Web of Science) were explored to isolate randomized controlled trials up to 10 February 2019. The anes thetic and analgesic efficacies were assessed using six evalu ation outcomes: onset of anesthesia, success of anesthesia, dur ation of anesthesia, duration of analgesia, pain score on the fourth postoperative hour, and number of analgesics consumed. Stata software (version 13, StataCorp) was used to analyze the data. Results: Fourteen studies met the specified criteria. The sample consisted of 1,078 mandibular third molar surgeries per formed in 858 patients. Bupivacaine, lidocaine/lignocaine, artic aine, etidocaine, levobupivacaine, and carbonated bupivacaine were the local anesthetics used. Compared with other anesthetic agents, bupivacaine showed longer duration of anesthesia (weighted mean difference [WMD] 123.431 minutes; 95% confi dence interval [CI] 34.01 to 212.851; P = .007), lower pain score at the fourth and eighth postoperative hours (4 hr-WMD 2.757; 95% CI 0.893 to 4.62; P = .004; 8 hr-WMD 1.697; 95% CI 1.178 to 2.216; P < .001), and lower number of analgesics requirement (WMD 0.663; 95% CI 0.258 to 1.067; P = .001). The onset of anes thesia was slower for bupivacaine (WMD 0.865 minutes; 95% CI 0.799 to 0.931; P < .001). However, for success of anesthesia (risk ratio 1.003; 95% CI 0.972 to 1.035; P = .831) and duration of an algesia (WMD 45.285 minutes; 95% CI −48.021 to 138.537; P = .342), the local anesthetic agents showed no significant dif ferences. Conclusions: Except for the onset of anesthesia, bupi vacaine showed better anesthetic and analgesic properties than other local anesthetic agents for mandibular third molar surgery.