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.