Does Liposomal Bupivacaine Reduce Postoperative Pain Following Third Molar Extractions? A Double-Blinded Randomized Controlled Trial

Abstract

Background

Liposomal bupivacaine (LB) is a long-lasting local anesthetic providing analgesia for several days. The current literature examining the efficacy of LB in pain management following third molar extractions remains unclear.

Purpose

The purpose of this study was to compare postoperative pain management between LB and standard bupivacaine (SB) in mandibular third molar extractions.

Study Design

A double-blinded randomized controlled trial of subjects undergoing bilateral mandibular third molar extractions at our institution from 2022 to 2024 was conducted using a split-mouth study design. Subjects were excluded if they received additional mandibular teeth extractions, were unable to complete the questionnaire, or had medical contraindications.

Predictor Variable

The predictor variable was postsurgical local anesthetic agent, and the sides of mouth were randomly assigned to LB or SB.

Main Outcome Variable(s)

Primary outcome was postoperative pain on a 10-point numerical rating scale (NRS), and the mean cumulative pain rating via area under the curve (AUC) analysis. Secondary outcomes were adverse events and ibuprofen or acetaminophen consumption.

Covariates

Demographics, procedure time, preoperative and perioperative local anesthetics used, and procedural difficulty coded as nonsurgical or surgical were collected.

Analyses

We used mixed-effects models to compare the NRS scores during each time period and paired t-tests to compare AUC values. Statistical tests included 95% CIs with alpha = 0.05.

Results

The study sample included 72 subjects (mean age 25.8, SD: 9). Pain was lower in the LB versus SB group on surgery day (NRS difference −0.75; P = .002) until the morning of postoperative day 2 (−0.68, P = .003). When limiting the analysis to bilateral surgical extractions, it was statistically significant until the morning of postoperative day 3 (−0.61, P = .02). AUC analysis showed cumulative pain reduction for the LB group in comparison to the SB group through all 4 postoperative days for the overall cohort (average AUC_0-96 difference 93.5, P = .005), with a similar effect for bilateral surgical extractions (101.88, P = .006).

Conclusion

LB modestly reduces pain following third molar extractions, with this difference more pronounced following surgical extractions. This suggests that LB may be more beneficial in complex extractions and greater pain-inducing surgeries.