Estudio comparativo entre la combinación de dexametasona y bupivacaína en el control del dolor postoperatorio tras la cirugía del tercer molarensayo clínico aleatorizado, triple ciego

Resumo

Objective: To compare the efficacy in reducing postoperative pain with an anesthetic block performed with articaine-epinephrine and submucosal reinforcement of dexamethasone-bupivacaine versus an anesthetic block performed with articaine-epinephrine (conventional procedure), after third molar surgery. Materials and methods: A phase 3, triple-blind, randomized, controlled and parallel clinical trial was carried out. The total number of participants was 184 patients who underwent surgery for the extraction of the impacted mandibular third molar, who were randomly divided into two groups: experimental (93 patients) with standard anesthetic block: articaine + epinephrine 40 / 0.005 mg / ml and submucosal reinforcement with dexamethasone 0.8 mg + 0.5% bupivacaine; and control group (91 patients) with exclusive standard block: articaine + epinephrine 40 / 0.005 mg / ml. To analyze the degree of postoperative pain, the visual analog scale (VAS) and a record of drug consumption were used at three times during the week after surgery (24h, 48h and 7th day). The mean values were compared using the Mann-Whitney U test for categorical variables, the χ2 test was used. Mean pain values at 24 h, 48 h, and 7 days within each group were compared using the Wilcoxon test. Results: The degree of postoperative pain on the first, second and seventh days was lower in the experimental group compared to the control group (p <0.001). The consumption of anti-inflammatory / analgesic drugs was also lower in the experimental group compared to the control group, throughout the study period (p <0.04). Conclusions: The combination of the dexamethasone + bupivacaine mixture as a reinforcement of the standard anesthetic procedure or as an alternative to the use of articaine in oral surgery, is justified, having been found to be more effective in the control of postoperative pain by reducing the number of patients patients on the visual analog scale, as well as their consumption of analgesics after surgery.