Comparison of Efficacy of 0.5% Ropivacaine Versus 2% Lignocaine Hydrochloride with Adrenaline (1:80,000) in Surgical Removal of Impacted Mandibular Third Molars with Emphasis on Depth of Anesthesia- Prospective, Randomized, Split Mouth Study

IntroductionA good anesthetic and analgesic effect is crucial for any minor surgical treatment to be successful. 2% Lignocaine hydrochloride with Adrenaline (1:80,000) is the most commonly used local anesthetic. However, it is not recommended for long procedures or in patients with cardiovascular diseases, where adrenaline is not desirable. Hence, need arises for a local anesthetic which has longer duration of action and adequate analgesic effect with minimal adverse reaction. 0.5% Ropivacaine is a long-acting amide local anesthetic with vasoconstrictive properties. It is considered to have superior properties compared to lignocaine in terms of duration of action and need for analgesics. This study compared the efficacy of 0.5% Ropivacaine versus 2% Lignocaine Hydrochloride with Adrenaline (1:80,000) in the surgical removal of impacted mandibular third molars.Materials and MethodA prospective, randomized, split mouth, cross over study was conducted amount 33 patients indicated for surgical extraction of impacted mandibular third molar. Extraction of one side was done using 2% Lignocaine with Adrenaline (1:80,000) and the opposite side was extracted one week later using 0.5% Ropivacaine. Parameters assessed were, pain on injection, time of onset of the local anesthetic, the depth and duration of anesthesia, intensity of pain and need for analgesics postoperatively.ResultsThere was no statistically significant difference between the two groups in terms of pain on injection. Time of onset was noted to be faster in the Lignocaine group. Ropivacaine was found to be superior to Lignocaine in terms of depth and duration of anesthesia and the postoperative analgesic effect. No adverse effect were noted in either of the two study groups.Conclusion0.5% Ropivacaine can be a suitable alternative to 2% Lignocaine in minor surgical procedures of long duration and in conditions, where the use of vasoconstrictor is contraindicated. It also provides an added benefit of greater depth of penetration into the bone along with a postoperative analgesic effect, thereby increasing the patient comfort. However, further study on a larger sample size is necessary to determine the overall effectiveness and practicality of using Ropivacine as an alternative to lignocaine in minor oral surgical procedures.