Comparison of anesthetic efficacy of 4% articaine with 2% lignocaine in surgical extraction of mandibular third molars: a double blinded randomised controlled clinical trial

Study Design: A prospective, randomized double-blind clinical trial was conducted (n=100)to compare the anesthetic efficacy of 4% articaine versus 2% lidocaine, with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars the Department of Oral and maxillofacial surgery at Government Dental College and Hospital, Nagpur, India. Single operator performed surgery on an extemporaneous basis. The study variables were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. Results: The mean anesthetic latency period for Articaine was found to be short (64.05 ± 10.25secs) as compared to Lignocaine (84.2 ± 10.61 secs) (p<0.0001). The duration of anaesthesia was longer for Articaine (275±48.10 mins) as compared to Lignocaine (198.66±39.30 mins) with p <0.0001.Subjective intra-operative pain scoring by the patients indicating depth of anesthesia showed no significant differences between the two. There was no significant differences between the need for re-anesthesia with Articaine or Lignocaine (p= 0.2919). The duration of onset of post-operative pain was 223.33±29.44 mins and 166.67±32.93 mins for Articaine and Lignocaine respectively, indicating longer anesthetic duration with Articaine (p<0.0001). There was no significant difference in pain intensity at different point times between the two groups (p=0.987). The post-operative analgesic requirement between two groups at different point times showed a quantitative difference in number of analgesics used after surgery (p<0.001) at all period of time, considering both anesthetic solution. Conclusion: Articaine was found to have longer duration of action than Lignocaine. Thus, adding to the patient comfort after extraction by increasing painless duration. Duration of analgesia was more with Articaine as compared to Lignocaine thus providing a larger pain-free post-operative period for patient after surgical extraction. Artcaine offers better post-operative analgesic effect clinically with a significant reduction in post-operative analgesic requirement as compared to Lignocaine thus increasing the patient comfort after surgical extraction and a faster recovery.