Bupivacaine may reduce post-operative pain in patients having single visit root canal treatment

shutterstock_17046487- endodontic treatment

Elimination of pain during and after root canal treatment is an important element of patient care and modern endodontic practice.  The aim of this study was to compare the postoperative pain and analgesic use after single-visit root canal treatment of acute irreversible pulpitis with either bupivacaine (a long-acting anaesthetic) or lidocaine.

Patients with a first or second mandibular molar tooth with acute irreversible pulpitis and normal periapical radiographic appearance without sensitivity to percussion that was suitable for restoration were included. Patients who had used any type of analgesic medication during the preceding 12 hours before the treatment were excluded. Patients were randomly assigned to either 0.5% bupivacaine with 1:200,000 epinephrine (n=36) or 2% lidocaine with 1:80,000 epinephrine (n=39) for inferior alveolar nerve block (IANB). Root treatment was conducted under rubber dam. Pain was recorded at 6, 12, 24, 36, 48, and 72 hours after treatment using a visual analogue scale. Patients were advised to use ibuprofen (400mg every 6hrs) if required.  Patients were reviewed at 1 week.

  • 15 patients (9 in lidocaine group, 6 in bupivacaine group) were excluded from follow up.
  • Pain at all time intervals is shown in the table.

[table id=35 /]

  • Patients who received bupivacaine as the anesthetic agent reported significantly lower postoperative pain levels at 6 and 12 hours compared with the patients who had received lidocaine (P < .05).
  • There was no significant difference in postoperative pain between the bupivacaine and lidocaine groups at the other time intervals (P > .05).
  • The use of analgesics in the bupivacaine patients was significantly lower than in the lidocaine group (P < .05)

The authors concluded

Patients who received bupivacaine as the anesthetic agent for single-visit endodontic treatment of irreversible pulpitis in mandibular molars had significantly less early postoperative pain and used fewer analgesics than those who had lidocaine as the anaesthetic.


The authors note that when considering the use of bupivacaine some short comings should be taken into consideration; slower speed of onset , possible lower success rate for IANB  and other side potential toxic side effects although the systematic review we noted in the Dental Elf earlier this week suggested a higher proportion of side effects with lidocaine.


Parirokh M, Yosefi MH, Nakhaee N, Manochehrifar H, Abbott PV, Reza Forghani F. Effect of bupivacaine on postoperative pain for inferior alveolar nerve block anesthesia after single-visit root canal treatment in teeth with irreversible pulpitis. J Endod. 2012 Aug;38(8):1035-9. Epub 2012 May 30. PubMed PMID: 22794202.

Dental Elf 1st October 2012



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. He is a former editor of the Evidence-Based Dentistry Journal, the chief blogger for the Dental Elf website and a past president of the British Association for the Study of Community Dentistry. He has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Retired from the NHS he is currently a part-time senior lecturer at Dundee Dental School.

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