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Trial registered on ANZCTR
Registration number
ACTRN12617001138370
Ethics application status
Approved
Date submitted
10/07/2017
Date registered
3/08/2017
Date last updated
3/08/2017
Type of registration
Retrospectively registered
Titles & IDs
Public title
Analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction
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Scientific title
Double-blind, randomized controlled trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction
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Secondary ID [1]
292407
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Nil known
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Universal Trial Number (UTN)
U1111-1198-9779
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
third molar surgery
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postoperative pain
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Condition category
Condition code
Oral and Gastrointestinal
303324
303324
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0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Anaesthesiology
303442
303442
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0
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Pain management
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Surgical extraction of lower third molars under local anesthesia with bupivacaine were performed. 0.5% bupivacaine with 1:200,000 epinephrine were administered subcutaneously before the surgical extraction. Between 2 and 4 carpules of bupivacaine were administered (2 ml per carpule). The number of carpules depended on the quaility of the intraoperative anesthesia achieved (If patient felt discomfort/pain and additional carpule were administered and recorded in the history)
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Intervention code [1]
298575
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Treatment: Drugs
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Comparator / control treatment
Active control (4% articaine with 1:100,000 epinephrine). Surgical extraction of lower third molars under local anesthesia with 4% articaine with 1:100,000 epinephrine administered subcutaneously before the surgical extraction. Between 2 and 4 carpules of articaine were administered. The number of carpules depended on the quaility of the intraoperative anesthesia achieved (If patient felt discomfort/pain and additional carpule were administered and recorded in the history)
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Control group
Active
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Outcomes
Primary outcome [1]
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Postoperative pain intentsity.
During the 48-h postoperative period, each patient completed a data collection form with the following outcome variables: postoperative pain intensity at 2, 4, 6, 8, 10, 12, 24, and 48 h, using a horizontal 100-mm visual analogue scale (VAS) with “no pain” and “worst pain imaginable” as end-points
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Assessment method [1]
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Timepoint [1]
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At 2, 4, 6, 8, 10, 12, 24, and 48 h post-surgery
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Secondary outcome [1]
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Consumption of rescue medication.
Each patient completed a data collection form with their need for rescue analgesia with 1 g paracetamol (yes/no) and its timing.
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Assessment method [1]
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Timepoint [1]
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At 2, 4, 6, 8, 10, 12, 24, and 48 h post-surgery
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Secondary outcome [2]
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The quality of intraoperative anesthesia.
It was classified as no discomfort during surgery, discomfort/pain not requiring additional anesthesia; or discomfort/pain requiring additional anesthesia.
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Assessment method [2]
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Timepoint [2]
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During the surgery
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Eligibility
Key inclusion criteria
All participants must be undergoning impacted third molar extraction. Caucasian participants, absence of general medical disorders, no allergy to the study medication or related drugs, no receipt of medication with analgesic or anti-inflammatory properties less than 24 h before the surgery, absence of preoperative inflammation and pain at the surgical site, and absence of clinical or radiographic evidence of active oral disease
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Minimum age
18
Years
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Maximum age
30
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Age under 18 yrs, renal failure, pregnancy or breast-feeding, allergy to the study medication or related drugs, immunocompromised status, psychological disorder, epilepsy, receipt of medication with analgesic or anti-inflammatory properties less than 24 h before the surgery, preoperative inflammation and pain at the surgical site, and clinical or radiographic evidence of active oral disease.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with the numbers 1 and 2, respectively
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A computer-generated random sequence was used to allocate participants
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The sample size was calculated using the Sample Sizer Release statistical program (Microsoft Office Excel 2011), with an alpha value of 0.05, statistical power of 80 %, and assumed loss to the follow-up of 15 %. According to this calculation, the number of patients required per group was 24, and we finally included 25 patients in each group.
SPSS v 20.0 software (SPSS Inc., Chicago, IL) was used for data analysis. Variable normality was verified with the Anderson-Darling test. The association between types of anesthesia and different variables was analyzed using the Fisher or Chi-square test.
Bupivacaine and articaine group data were compared at each time-point using the Mann-Whitney U test. The proportions of individuals requiring rescue medication in each group were compared with a proportion test based on binomial distribution. P< 0.05 was considered significant in all tests.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
1/04/2014
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Date of last participant enrolment
Anticipated
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Actual
31/03/2016
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Date of last data collection
Anticipated
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Actual
30/04/2016
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Sample size
Target
50
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Accrual to date
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Final
50
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Recruitment outside Australia
Country [1]
9044
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Spain
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State/province [1]
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Granada
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Master of Oral Surgery and Implant Dentistry, University of Granada, Spain
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Address [1]
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Colegio Maximo s/n, Campus de Cartuja, Granada. 18071
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Country [1]
296958
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Spain
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Primary sponsor type
University
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Name
Master of Oral Surgery and Implant Dentistry, University of Granada, Spain
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Address
Colegio Maximo s/n, Campus de Cartuja, Granada. 18071
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Country
Spain
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Secondary sponsor category [1]
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University
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Name [1]
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Departmento of Stomatology, School of Dentistry, University of Granada
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Address [1]
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Colegio Maximo s/n, Campus de Cartuja, Granada. 18071
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Country [1]
295961
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Spain
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Ethics committee of the University of Granada
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Ethics committee address [1]
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Colegio Máximo s/n, Campus de Cartuja, Granada. 18071
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Ethics committee country [1]
298164
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Spain
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Date submitted for ethics approval [1]
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01/01/2014
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Approval date [1]
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27/02/2014
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Ethics approval number [1]
298164
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Summary
Brief summary
Objectives The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction. Materials and Methods The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18-30 yrs) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Measurements were conducted of postoperative pain intensity, using a visual analogue scale (VAS), rescue medication requirement and its timing, and the quality of intraoperative anesthesia. Results VAS-measured pain intensity was significantly higher (p<0.05) in the articaine group than in the bupivacaine group at all time-points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p=0.252). The groups did not significantly differ (p=0.391) in the quality of the intraoperative anesthesia. Conclusions Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery. Clinical relevance. These findings suggest that bupivacaine may be useful as coadjuvant to control acute postoperative pain.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Francisco Javier Manzano-Moreno
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Address
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Department of Stmatology, School of Dentistry, University of Granada.
Campus de Cartuja s/n, 18071, Granada.
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Country
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Spain
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Phone
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+34651606228
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
76191
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Francisco Javier Manzano-Moreno
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Address
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Department of Stmatology, School of Dentistry. University of Granada.
Campus de Cartuja s/n. 18071. Granada
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Country
76191
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Spain
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Phone
76191
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+34651606228
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Fax
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Email
76191
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[email protected]
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Contact person for scientific queries
Name
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Francisco Javier Manzano-Moreno
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Address
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Department of Stmatology, School of Dentistry. University of Granada.
Campus de Cartuja s/n. 18071. Granada
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Country
76192
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Spain
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Phone
76192
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+34651606228
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Fax
76192
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Email
76192
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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