In patients undergoing third molar surgery, bupivacaine has superior efficacy in terms of alleviating post-surgery pain as well as intake of analgesic drugs after surgery when compared to articaine.

A randomized, triple-blind, parallel, controlled, phase 3 trial was performed to explore the efficacy and the possible advantages of a combination of dexamethasone-bupivacaine with articaine-epinephrine as an anesthetic block following oral surgery. 

Participants were segregated to (i) Experimental group (n=93) with a standard anaesthetic block: 40/0.005 mg/mL articaine-epinephrine and submucosal reinforcement with 0.8 mg dexamethasone-5% bupivacaine; and (ii) Control group (n=91) with standard block: 40/0.005 mg/mL articaine-epinephrine. For determining postsurgery pain, a visual analogue scale (VAS) was utilized.

The groups were homogeneous, without profound differences associated with epidemiological variables. The postsurgery pain among the 1st, 2nd  and 7th  postsurgery days was substantially reduced in the experimental group in comparison with the control group, as shown in Table 1:

Throughout the study period, drug consumption was reduced in the experimental group.

For oral surgical procedures, bupivacaine can be used as an alternative to articaine. Compared to articaine, bupivacaine is more effective in decreasing patients' scores on the VAS and minimizing the intake of analgesic drugs following third molar surgery.