Ispitivanje efikasnosti lokalne anestezije primenom ropivakaina sa deksametazonom u hirurgiji donjeg impaktiranog umnjaka

Abstract

The aim of the study was examine whether Dexamethasone (perineural injection,1ml/4mg) as part of the Gaw-Gates mandibular conduction anesthesia (Ropivacaine 4ml/0.5%) affects the qualityand duration of both peri-and postoperative anesthesia, as well as swelling, trismus, and decreased stress, measured by salivary cortisol levels, related to the surgical extraction of impacted mandibular wisdom teeth. A prospective randomized study was conducted in 60 participants, divided into 3 groups of 20 patients who received 4ml of 0.5% Ropivacaine and 1ml / 4mg dexamethasone (Group I); 4ml of 0.5% Ropivacaine and 1ml of 0.9% sterile physiological solution (Group II); and 4ml of 0.5% Bupivacaine and 1ml of 0.9% sterile physiological solution (Group II) respectively. Perioperative anaesthesia and analgesia were measured subjectively by the participants according to the pain and anaesthesia rating scales and objectively according to the SISK Scale.The postoperative swelling and trismus were measured according to the cephalometric facial points distance and interincisal distance. Preoperative anxiety was measured according to the Norman Corah Scale. Salivary Cortisol levels (measured by ELISA method) and hemodynamic parameters were taken before the procedure, immediately after it and during the first follow-up appointment. The results showed that Group I had a, both subjectively (p = 0.003). and objectively (p = 0.007), better quality of interoperative anaesthesia and a statistically longer duration of perioperative anaesthesia (~ 9h; p <0.001) and postoperative analgesia (~ 9.5h; p <0.001), compared to the other two groups. Additionally, reduced consumption of (p = 0.001) and increased absence of need for perioperative analgesics (p = 0.005), was observed in Group I. Furthermore, in comparison to the other two groups, Group I had statistically less postoperative swelling (p <0.001) and trismus (p <0.001) and statistically lower levels of salivary Cortisol (P = 0.050). Based on the obtained results, it is concluded that using 4ml of 0.5% of Ropivacaine with the addition of 1 ml of 0.4% Dexamethasone as local aesthesia, had significantly better effect on the quality and length of perioperative anaesthesia and postoperative analgesia; on reducing the postoperative consumption of analgesics; and on the overall homeostasis following the impacted lower wisdom tooth surgery.