Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial

Purpose: The objective of this triple-blind, randomized, placebo-controlled trial was to assess the clinical analgesic efficacy of 0.5% bupivacaine in acute postoperative pain management after bilateral sagittal split ramus osteotomy (BSSO). Methods: Patients were randomly allocated into the experimental (0.5% bupivacaine with 1:200000 epinephrine) or control group (normal saline – placebo) using block randomization. The interventions were administered at the inferior alveolar nerve block and buccal nerve block sites bilaterally after the BSSO surgery. Analgesic efficacy was assessed in terms of the patient's pain perception measured by a numerical rating scale (0 to 10), rescue drug requirement, and duration of analgesia for 24 hours after the surgery. The statistical analysis was blinded to the allocation groups, and P-value of <.05 was considered as a significant difference for all tests. Results: In total, 28 patients underwent BSSO (ie, 14 in each group). There was no significant difference in pain perception of patients injected with 0.5% bupivacaine and those administered with placebo during the 24 hours after the surgery (P > .05). Three patients in the bupivacaine group took the rescue drug after the surgery (mean duration - 268 minutes) and 1 patient in the placebo group took the rescue drug after 27 minutes. Conclusions: Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative pain after BSSO.