Lidocaine vs Bupivacaine for Postoperative Pain

Overseen By Katie Bridges

Age: < 65

Sex: Any

Trial Phase: Phase 4

Sponsor: Boston Children's Hospital

Disqualifiers: Chronic pain, Allergic reactions, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 5

Duration: 1 day

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two local anesthetics, bupivacaine and lidocaine, to assess their effectiveness in pain control after jaw surgery. Both are commonly used in dental surgeries but differ in onset and duration. The trial aims to determine which provides better pain relief and overall patient experience post-surgery. Candidates for this trial include individuals undergoing jaw surgery at Boston Children's Hospital who have no history of chronic pain or allergies to these medications. As a Phase 4 trial, this research involves FDA-approved treatments and seeks to understand their benefits for more patients, offering participants the opportunity to contribute to improving post-surgical care.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What is the safety track record for these treatments?

Research has shown that both bupivacaine and lidocaine are generally safe and well-tolerated for numbing specific areas of the body. Bupivacaine is often combined with other medications to enhance pain relief, as studies have found it effectively reduces pain after surgeries like hemorrhoid removal. However, it may not always outperform a simple saltwater solution for pain control after some surgeries. Some studies have mentioned possible side effects, but they were not detailed.

Lidocaine is commonly used to ease pain after surgery and is considered safe. Patients using lidocaine reported feeling less pain, though its effect on overall quality of life after surgery remains uncertain. Overall, lidocaine is known for its pain-relieving properties and safety.

Both bupivacaine and lidocaine are frequently used in dental and surgical procedures, indicating a strong safety record. Since this study is in Phase 4, these drugs have already been approved and widely used, which usually indicates they are considered safe. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about these treatments because they explore the effectiveness of lidocaine and bupivacaine, two local anesthetics, in managing postoperative pain after jaw surgery. Unlike typical oral pain medications, these treatments are administered directly as peripheral nerve blocks, which may provide targeted pain relief right at the source. Bupivacaine offers a longer duration of action, while lidocaine acts faster, allowing for potentially balanced pain management. This trial could reveal optimal combinations of these drugs, leading to improved pain control and quicker recovery for patients undergoing similar procedures.

What evidence suggests that this trial's treatments could be effective for postoperative pain?

This trial will compare the effectiveness of bupivacaine and lidocaine for postoperative pain relief. Research has shown that bupivacaine does not relieve pain after surgery better than a simple saltwater solution. Several studies have found it doesn't significantly reduce pain after surgeries like jaw surgery. In contrast, research indicates that lidocaine can help reduce pain and swelling when used before or during surgery. Overall, lidocaine appears more effective for pain relief than bupivacaine. Participants in this trial will receive both bupivacaine and lidocaine, with one side of the jaw treated with bupivacaine and the other with lidocaine, to directly compare their effectiveness. ^{2 3 6 7 8}

Who Is on the Research Team?

Mark A Green, DDS, MD

Principal Investigator

Boston Children's Hospital, Department of Plastic and Oral Surgery

Are You a Good Fit for This Trial?

This trial is for individuals aged 15-35 undergoing jaw surgery at Boston Children's Hospital. It aims to compare the effects of two local anesthetics on patient recovery.

Inclusion Criteria

I am scheduled for jaw surgery at Boston Children's Hospital.

I am between 15 and 35 years old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

4-6 weeks

1 visit (in-person)

Treatment

Participants undergo orthognathic surgery with administration of bupivacaine and lidocaine as local anesthetics

1 day

1 visit (in-person)

Immediate Postoperative Assessment

Participants are assessed for numbness, light touch perception, temperature sensation, and pain approximately one hour and four hours after surgery

1 day

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness, including assessments of numbness, light touch perception, temperature sensation, and pain one week after surgery

1 week

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Bupivacaine
• Lidocaine

Trial Overview The study tests lidocaine and bupivacaine, both used in dental procedures, to see which provides better outcomes post-surgery. Patients will receive one of these drugs during their operation.

How Is the Trial Designed?

Group I: Bupivacaine Left, Lidocaine Right Active Control 2 Interventions

Group 1 will receive 10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine on the left side of their jaw and 6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine on the right side of their jaw. This dosage will be administered once as peripheral nerve blocks at the beginning of the participant's orthognathic procedure.

Group II: Bupivacaine Right, Lidocaine Left Active Control 2 Interventions

Group 2 will receive 10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine on the right side of their jaw and 6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine on the left side of their jaw. This dosage will be administered once as peripheral nerve blocks at the beginning of the participant's orthognathic procedure.

Bupivacaine is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Marcaine for:

• Local anesthesia for surgery
• Acute pain management
• Spinal anesthesia

Approved in European Union as Marcaine for:

• Local anesthesia for surgery
• Acute pain management
• Spinal anesthesia

Approved in Canada as Sensorcaine for:

• Local anesthesia for surgery
• Acute pain management
• Spinal anesthesia

Who Is Running the Clinical Trial?

Boston Children's Hospital

Lead Sponsor

Trials

801

Recruited

5,584,000+

Published Research Related to This Trial

Bupivacaine hydrochloride (Marcaine) is highlighted for its increased duration of action compared to other local anesthetics, making it particularly useful in oral surgery.

It also has a favorable potency to toxicity ratio, suggesting that it provides effective pain relief with a lower risk of adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bupivacaine: a review. Babst, CR., Gilling, BN.[2018]

Bupivacaine, a long-acting local anesthetic, provided significantly longer postoperative anesthesia (5.62 hours) compared to lidocaine (2.47 hours) after periodontal surgery in a study involving 10 male subjects.

Patients who received bupivacaine reported significantly less pain and required fewer analgesics (1.60 tablets) compared to those who received lidocaine (3.70 tablets), indicating its superior efficacy in managing postoperative pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of postoperative bupivacaine with lidocaine on pain and analgesic use following periodontal surgery. Kaurich, MJ., Otomo-Corgel, J., Nagy, RJ.[2013]

The bupivacaine implant (XARACOLL) significantly reduced pain intensity in the first 24 hours after abdominoplasty compared to placebo, indicating its efficacy in providing postoperative analgesia.

Patients receiving the bupivacaine implant had a higher percentage of opioid-free patients at 24, 48, and 72 hours post-surgery, suggesting it may help reduce reliance on opioids for pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a bupivacaine hydrochloride implant in patients undergoing abdominoplasty. Beaton, AC., Solanki, D., Salazar, H., et al.[2023]

In a study involving 30 patients, two forms of 0.5% bupivacaine hydrochloride (Anecaine and Marcaine) were compared for epidural anesthesia, revealing differences in how quickly and effectively they provided pain relief.

Anecaine showed a shorter onset of analgesia at the catheter site but a delayed effect in peripheral areas compared to Marcaine, indicating that even the same active ingredient can behave differently based on the manufacturer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A clinical trial of the use of 2 forms of bupivacaine hydrochloride (Anecaine and Marcaine) for epidural anesthesia]. Kozlov, SP., Vashchinskaia, TV., Svetlov, VA.[2013]

Bupivacaine (Marcaine) is effective for epidural analgesia in obstetrics, providing excellent sensory block with minimal impact on motor function and few side effects for both mothers and newborns.

When used at concentrations below 0.5%, and with careful dosing during labor, the risk of side effects and toxicity is low, and significant effects on newborns are rare due to the drug's high protein binding limiting its transfer across the placenta.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The use of Marcaine in obstetrical analgesia]. Seebacher, J., Chareire, F., Galli-Douant, P., et al.[2013]

In a randomized clinical trial involving 30 patients undergoing lower abdominal surgery, the combination of bupivacaine and lidocaine provided longer postoperative analgesia compared to lidocaine alone.

Both groups experienced similar latency periods and no serious complications, indicating that the bupivacaine + lidocaine mixture is a safe and effective option for epidural anesthesia in this surgical setting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Postoperative analgesia using epidural administration of bupivacaine plus lidocaine]. Rodríguez-Nava, A., Castañeda-Baena, R., Ramírez-Ramírez, M., et al.[2013]

In a study involving 20 patients undergoing standardized periodontal surgery, bupivacaine HCl resulted in significantly less postoperative pain and a longer duration of numbness compared to lidocaine HCl.

Patients reported a strong preference for bupivacaine, which also led to fewer analgesics being taken post-surgery, indicating its potential for improved pain management in periodontal procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of postoperative pain experience following periodontal surgery using two local anesthetic agents. Linden, ET., Abrams, H., Matheny, J., et al.[2013]

In a study of 37 patients undergoing breast reduction surgery, the use of the long-acting local anesthetic bupivacaine (Sensorcaine) significantly reduced the time to discharge from the postanesthesia care unit, averaging 2.9 hours compared to 3.8 hours for the placebo group.

Patients who received Sensorcaine reported lower pain levels and required significantly less narcotic medication post-surgery, taking an average of 3.5 tablets compared to 6.4 tablets in the control group, indicating its efficacy in managing postoperative pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty. Culliford, AT., Spector, JA., Flores, RL., et al.[2021]

In a study of 435 patients, bupivacaine (0.75% in 8.25% dextrose) demonstrated superior efficacy compared to tetracaine for spinal anesthesia, with only one unsatisfactory anesthesia case in the bupivacaine group versus 19 in the tetracaine group for the lower dose.

Bupivacaine was found to be a safe and reliable option for spinal anesthesia, although tetracaine provided longer motor blockade; adding epinephrine to either anesthetic significantly extended their duration of action.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Spinal anesthesia: bupivacaine compared with tetracaine. Moore, DC.[2013]

In a study of 130 patients, 50 mg of plain 1% 2-chloroprocaine was found to have a similar onset time for sensory block at the T10 level compared to 10 mg of plain 0.5% bupivacaine, supporting its use as an effective spinal anesthetic.

2-chloroprocaine demonstrated faster recovery times for motor block, sensory block resolution, and overall ambulation compared to bupivacaine, with no reported cases of transient neurological symptoms, indicating a potentially safer profile.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intrathecal 1% 2-chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer-blinded, randomised, controlled trial. Camponovo, C., Wulf, H., Ghisi, D., et al.[2014]

Citations

1. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0278239121007552

A Triple-Blind Randomized Controlled Clinical Trial Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative pain after BSSO.

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/34547270/

A Triple-Blind Randomized Controlled Clinical Trial Conclusions: Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT06531603

Postoperative Analgesic Effectiveness of Bupivacaine With ... Postoperative Analgesic Effectiveness of Bupivacaine With and Without Dexmedetomidine in Patients With Abdominal Surgery. ClinicalTrials.gov ID NCT06531603.

4. researchgate.net researchgate.net/publication/353881774_Postoperative_Pain_Management_Using_Supplemental_Bupivacaine_After_Mandibular_Orthognathic_Surgery_A_Triple-Blind_Randomized_Controlled_Clinical_Trial

A Triple-Blind Randomized Controlled Clinical Trial Conclusions: Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative ...

5. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2777506

Standard vs Liposomal Bupivacaine for Postoperative Pain ... A more recent trial showed no difference in opioid use within 48 hours after laparotomy for gynecologic surgery. Few studies analyze liposomal ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7002882/

Effect of bupivacaine on postoperative pain and analgesics ... Bupivacaine did not decrease pain and analgesics use. When surgery exceeded 40 minutes, bupivacaine use might be associated with less pain and less analgesics ...

7. frontiersin.org frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1331965/full

The effect of bupivacaine on analgesia and safety in ... The results indicated that bupivacaine-combined other drugs had a good effect on pain relief after hemorrhoidectomy, but the adverse reactions ...

8. nature.com nature.com/articles/s41598-025-17790-9

Preclinical safety and feasibility of a bupivacaine-loaded ... Poorly controlled pain following skeletal surgery is a common clinical problem, and increases the risk of chronic postoperative pain12,13,14.