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Anesthesia

(3) Exparel Versus Bupivacaine in Postoperative Pain Control Following Bilateral Third Molar Extraction: A Prospective Single-Blind Randomized Clinical Trial

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT
Disclosure(s):
Mohammed Louay Taifour, DMD: No financial relationships to disclose
Abstract:

Background: Pain following third molar extractions is a prevalent issue, leading to the development of numerous pain management strategies, including surgical modifications, oral analgesics, and locally applied medications. Despite these alternatives, opioid analgesics remain commonly prescribed, increasing the risk of addiction and contributing to the opioid crisis.

Objective: This study aims to evaluate postoperative analgesia and oral analgesic consumption in patients undergoing bony impacted third molar extractions, comparing the effects of EXPAREL (liposomal bupivacaine) and standard bupivacaine.
Study

Design: This prospective, randomized, controlled, single-blinded trial involved bilateral infiltrations with 1.3% liposomal bupivacaine EXPAREL (study group) or 0.5% bupivacaine with 1:200,000 epinephrine (control group) following extraction of bony impacted mandibular third molars. The study was conducted at the Oral and Maxillofacial Surgery outpatient clinics at Case Western Reserve University, School of Dental Medicine. Participants included patients aged 18 years or older undergoing bilateral third molar extractions under local and general anesthesia.
In this study, patients received bilateral infiltrations with either 6 mL of 1.3% liposomal bupivacaine EXPAREL (study group) or 3.6 mL of 0.5% bupivacaine with 1:200,000 epinephrine (control group). The outcomes for the first 96 hours postoperatively included self-reported pain levels, adverse effects, NSAID and narcotic use.

Results: The study is ongoing. Preliminary data from a total of 48 patients, with 25 in the control group (0.5% bupivacaine with 1:200,000 epinephrine) and 23 in the study group (1.3% liposomal bupivacaine EXPAREL), show early trends in postoperative pain control and analgesic consumption.