Salivary Cortisol Response After Ropivacaine-Dexamethasone Administration: A Randomized Clinical Trial

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Endocrinology

Background:

• Perioperative stress response is a critical factor in surgical outcomes.
• Salivary cortisol is a reliable biomarker for assessing stress.
• Impacted mandibular third molar extraction is a common surgical procedure often associated with significant stress.

Purpose of the Study:

• To evaluate salivary cortisol levels as a biomarker of perioperative stress.
• To compare the effects of ropivacaine with dexamethasone versus ropivacaine or bupivacaine alone on stress response.
• To assess the efficacy of anesthetic combinations in managing neuroendocrine stress during oral surgery.

Main Methods:

• A randomized parallel-group clinical study involving 90 patients.
• Patients received inferior alveolar nerve block with ropivacaine + dexamethasone (R+D), ropivacaine (R), or bupivacaine (B).
• Salivary cortisol was measured pre-anesthesia, and 15 minutes and 24 hours postoperatively.

Main Results:

• No significant differences in preoperative anxiety or baseline cortisol.
• Significant intergroup differences in cortisol levels were observed at 15 minutes and 24 hours postoperatively.
• The R+D group showed significantly lower cortisol levels at both 15 minutes and 24 hours compared to the R and B groups.

Conclusions:

• Ropivacaine-dexamethasone significantly reduced perioperative salivary cortisol levels.
• This effect is likely due to dexamethasone's suppression of the hypothalamic-pituitary-adrenal axis and enhanced analgesia.
• This anesthetic approach may improve physiological stability and postoperative recovery in oral surgery.