# Abstract

 

## Background: Minor oral surgical procedures are the most commonly performed procedures by oral and maxillofacial surgeons. Performance of painless surgical procedure is highly appreciated by the patients and is possible through the use of local anesthesia, conscious sedation or general anesthesia. Postoperative pain can also be controlled by the use of opioids, as opioid receptors exist in the peripheral nervous system and offers the possibility of providing postoperative analgesia in the surgical patient. The present study compares the efficacy of 0.5% bupivacaine versus 0.5% bupivacaine with 0.3 mg buprenorphine in minor oral surgical procedures. 

## Patients and Methods: The present study was conducted in 50 patients who required minor oral surgical procedures under local anesthesia. Two types of local anesthetic solutions were used- 0.5% bupivacaine with 1:200000 epinephrine in group I and a mixture of 39 ml of 0.5% bupivacaine with epinephrine 1:200000 and 1 ml of 300 μg buprenorphine (3 μg/kg)in group II. Intraoperative and postoperative evaluation was carried out for both the anesthetic solutions. 

## Results: The mean duration of postoperative analgesia in bupivacaine group (508.92 ± 63.30 minutes) was quite less than the buprenorphine combination group (1840.84 ± 819.51 minutes). The mean dose of postoperative analgesic medication in bupivacaine group (1.64 ± 0.99 tablets) was higher than buprenorphine combination group (0.80 ± 1.08 tablets). There was no significant difference between the two groups regarding the onset of action of the anesthetic effect and duration of anesthesia. 

## Conclusion: Buprenorphine can be used in combination with bupivacaine for patients undergoing minor oral surgical procedures to provide postoperative analgesia for a longer duration. # RESULTS Out of total 50 patients selected for the study, there were 29 (58%) male and 21 (42%) female \[ [Figure 1](#)\]. The mean age of patients was 27.60 years in bupivacaine group and 27.50 years in buprenorphine combination with bupivacaine group. <figure> <p><img src="" /></p> <figcaption>Demographic data</figcaption> </figure> Patients were divided into two groups and the surgical procedures included surgical removal of impacted mandibular third molars, incision and drainage of space infections, enucleation of cysts, dentoalveolar fractures, isolated mandibular fractures, maxillary fractures, elective implant removal, and excision of tumors \[ [Figure 2](#)\]. <figure> <p><img src="" /></p> <figcaption>Various minor oral surgical procedures done</figcaption> </figure> In both groups, the minimum volume of anesthetic solution used was 4 ml. However, the mean volume of bupivacaine solution including the amount needed for infiltration/reanesthesia was slightly higher (4.15 ± 0.52 ml) than the mean volume of buprenorphine combination with bupivacaine solution (4.12 ± 0.60 ml). The difference in the mean volume of both the solutions used was found to be statistically nonsignificant ( *P* = 0.84). The mean subjective onset of action in bupivacaine group (3.00 ± 1.08 min) was slightly longer than buprenorphine combination group (2.92 ± 1.03 min) whereas, on pinprick test, reverse was the case with the mean of 7.40 ± 1.93 min in buprenorphine combination group and 7.28 ± 1.59 min in bupivacaine group \[ [Table 1](#)\]. Statistically, no significant difference was observed between both groups regarding subjective ( *P* = 0.79) and objective onset of action ( *P* = 0.81). ::::table-wrap

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Evaluation of onset of action
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![](<>):::: Similarly, there was no significant difference in the duration of surgical procedure ( *P* = 0.76) and duration of anesthesia with respect to initial recovery from anesthesia and complete recovery of sensation in both groups ( *P* = 0.32, *P* = 0.63, respectively). However, the mean duration of postoperative analgesia in bupivacaine group (508.92 ± 63.30 min) was observed to be quite less than buprenorphine combination group (1840.84 ± 819.51 min), and value was found to be highly significant statistically ( *P* < 0.001) \[ [Table 2](#)\]. ::::table-wrap
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Evaluation of duration of anesthesia, postoperative analgesia, and
duration of surgery
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![](<>):::: On comparing the total amount of analgesic medication ingested during the postoperative period, the mean dose of analgesic medication in bupivacaine group (1.64 ± 0.99 tablets) was observed to be higher than buprenorphine combination group (0.80 ± 1.08 tablets). The difference between both the anesthetic solutions regarding number of analgesic tablets was found to be statistically significant ( *P* = 0.006) \[ [Table 3](#)\]. ::::table-wrap
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Evaluation of analgesic medication
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![](<>):::: The percentage of patients who had taken analgesic medication in the early postoperative period (1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 h) and in the later postoperative period (12, 24, 36 and 48 h) was compared in both the groups, and it revealed that the patients in buprenorphine combination group had significantly less pain during both periods \[ [Figure 3](#)\]. At the end of 10 h, all patients (100%) in buprenorphine combination group were pain free, as compared to only 4% of patients who were absolutely pain free in bupivacaine group. In this group, 12% of patients had mild pain but did not take analgesic medication. Only 84% of patients took analgesic medication till the 10 ^th^ h evaluation. However, at 12, 24, and 36 h, 4%, 12%, and 16% of patients, respectively, in buprenorphine combination group had taken analgesic medication as compared to 100% of patients in bupivacaine group at all-time intervals. At the 48 ^th^ h, 20% of patients were still pain free in buprenorphine combination group as compared to no pain-free patient in bupivacaine group. <figure> <p><img src="" /></p> <figcaption>Patients who had taken analgesic medication</figcaption> </figure> The difference between number of analgesic tablets taken in both groups was statistically highly significant at the 10 ^th^, 12 ^th^, 24 ^th^, 36 ^th^, and 48 ^th^ h ( *P* < 0.001) \[ [Table 4](#)\]. ::::table-wrap
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Percentage of patients who had taken analgesic medication
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![](<>):::: The efficacy of postoperative analgesia was recorded with the help of 100 mm-length VAS in both the groups \[ [Figure 4](#)\]. Till the 5 ^th^ postoperative hour, the *P* value was found to be statistically insignificant as all the patients in buprenorphine combination group had no pain and only three patients in bupivacaine group had very mild pain. Difference in median postoperative pain score between both anesthetic solutions was found to be statistically significant at the 6 ^th^ and 10 ^th^ h ( *P* = 0.001). However, it was observed to be statistically highly significant from 7 ^th^ h to 9 ^th^ h ( *P* < 0.001). As all the patients in the bupivacaine group had taken analgesic medication by the 12 ^th^ h, they were excluded from further statistical analysis \[ [Table 5](#)\]. <figure> <p><img src="" /></p> <figcaption>Evaluation of pain using visual analog scale</figcaption> </figure> ::::table-wrap
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Evaluation of pain using visual analog scale
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![](<>):::: None of the patients in either group reported opioid-related side effects such as nausea, vomiting, pruritus, or any evidence of respiratory depression during intraoperative and postoperative assessment.


Extracted trial result:
Outcome: objective onset of action (continuous)
Intervention: 0.5% bupivacaine with 1:200000 epinephrine in group I
Comparator: mixture of 39 ml of 0.5% bupivacaine with epinephrine 1:200000 and 1 ml of 300 _g buprenorphine (3 _g/kg)in group II
Intervention mean: 7.4
Intervention standard deviation: 1.93
Comparator mean: 7.28
Comparator standard deviation: 1.59
Notes: Found in abstract and results