Ropivacaine versus placebo on postoperative analgesia and chronic pain following third molar extraction: A Prospective Randomized Controlled Study

Abstract Purpose: The present study aimed at assessing the efficiency of ropivacaine on post-operative pain for extraction of third molars. Methods: In a single centre, prospective, parallel, double blind randomised trial, patients scheduled for removal of all four third molars, ASA I-III patients 3/10, followed by oral tramadol 50 mg after discharge), patient satisfaction, chronic pain (1-3 month), time in PACU and total hospitalization time were also recorded. Results: 50 patients were analysed in each group with similar characteristics (ropivacaine vs control, for age (years) 18 [17 - 21] vs 18 [17 - 21], for sex (female) 33 (66%) vs 25 (50%), and BMI (Kg/m2): 20 [19-23] vs 21 [19 -23]). Area Under the Curve for VAS pain (0 to 4h) was lower for Ropivacaine group: 0.43 [0.19-0.66] vs 0.63 [0.43-0.87], p=0.005. Use of morphine in PACU (8 vs 18, p =0.02) and median length of stay in ambulatory setting (5 vs 6 h, p=0.03) were reduced in Ropivacaine vs Placebo group. At days 1 and 4, VAS of pain was higher in Ropivacaine group (respectively 4 vs 2, p=0.006 and 3 vs 2, p=0.05). At month 1 and 3, pain and DN4 score were similar between groups, with a median VAS pain score at 0 for both groups (p=0.42). No difference was observed for patient satisfaction and adverse events. Conclusions: Ropivacaine provides an immediate efficient pain relief after extraction of third molars without benefit after discharge.