Liposomal Bupivacaine Reduces Opioid Use Following Third Molar Surgery: A Randomized Controlled Trial

Area of Science:

• Dental Surgery
• Anesthesiology
• Pharmacology

Background:

• Third molar extraction is a common procedure leading to initial opioid exposure in adolescents.
• Exparel (liposomal bupivacaine) presents a potential strategy to mitigate postoperative opioid use.

Purpose of the Study:

• To compare postoperative pain and opioid consumption between liposomal bupivacaine plus standard local anesthesia and standard local anesthesia alone after third molar extractions.
• To evaluate the efficacy of liposomal bupivacaine in reducing opioid requirements in adolescent patients.

Main Methods:

• A randomized, single-blind study involving 93 adolescent patients undergoing four impacted third molar extractions.
• Patients received either standard local anesthesia or standard local anesthesia with liposomal bupivacaine.
• Outcomes measured included opioid use, cumulative opioid consumption (morphine milligram equivalent), and pain scores (FACES pain scale) through postoperative day 5.

Main Results:

• Opioid use was significantly lower in the liposomal bupivacaine group (26%) compared to the control group (53%) (P=.022).
• Cumulative mean morphine milligram equivalent consumption was significantly reduced in the liposomal bupivacaine group (5.7) versus the control group (12.4) (P=.015).
• No significant difference in postoperative pain scores was observed between the groups (P=.3).

Conclusions:

• Liposomal bupivacaine effectively reduces opioid consumption following third molar extractions in adolescents.
• This analgesic strategy offers a promising alternative to traditional pain management, without compromising pain control.