Lidocaine Versus Bupivacaine in Orthognathic Surgery

NCT ID: NCT06450028

Last Updated: 2025-12-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-07-26

Study Completion Date

2025-11-30

Brief Summary

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In this research study, we want to learn more about the impact of two different local anesthetics (bupivacaine and lidocaine) on patient experience following orthognathic (jaw) surgery. Both anesthetics are within the standard of care for dental and orthognathic procedures, but can vary in how quickly they take action and how long they last. This study will provide us with a greater understanding of how anesthetic choice affect patient outcomes, and how we can strive to make these outcomes as favorable as possible.

Detailed Description

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Aim 1: To determine if differences exist in patient-reported outcomes regarding the use of bupivacaine and lidocaine in orthognathic surgery.

Aim 2: To assess patient experiences with pain, numbness, light touch perception, temperature sensation and narcotic and pain medication consumption following administration of bupivacaine and lidocaine in orthognathic surgery.

Lidocaine (known as lignospan commercially) and bupivacaine (known as marcaine or sensorcaine commercially) are two local anesthetics used ubiquitously for procedures in the oral cavity. Lidocaine is known for its fast-acting properties, which can take effect within one to two minutes of administration. However, lidocaine also has a relatively short duration of action, typically lasting about one to two hours. On the other hand, bupivacaine is slightly slower acting (tales effect in 10-15 minutes) but has a much longer duration of action (up to eight hours). Both local anesthetics are used in orthognathic surgery (jaw surgery) and are within the standard of care for these procedures. Lidocaine and bupivacaine are both administered with epinephrine as an additive to reduce bleeding in the operative field and improve the depth and duration of anesthesia. Some patients may experience significant pain postoperatively if their local anesthetic is metabolized too quickly, while others may experience prolonged numbness and decreased sensation if their local anesthetic has too long of a duration of action.

Patients will be randomized into two equally sized groups. Group 1 will receive 0.25% bupivacaine hydrochloride and epinephrine 1:200,000 on the left side of their mandible and/or maxilla and 2% lidocaine hydrochloride with 1:100,000 epinephrine on the right side of their mandible and/or maxilla. Group 2 will receive 0.25% bupivacaine hydrochloride and epinephrine 1:200,000 on the right side of their mandible and/or maxilla and 2% lidocaine hydrochloride with 1:100,000 epinephrine on the left side of their mandible and/or maxilla. The use of bupivacaine and lidocaine are common practice in orthognathic surgery and are frequently used in conjunction with each other. Email reminders will be sent to the oral surgeon reminding them that their patients is enrolled in this study. Following that email, another email will be sent to the oral surgeon by another individual to inform them of which side they are able to administer which anesthetic. This allows the research staff member performing postoperative assessments to remain blinded.

Conditions

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Pain, Postoperative Numbness Temperature Sensation Perception of Touch

Keywords

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orthognathic surgery lidocaine bupivacaine Le Fort I bilateral sagittal split osteotomy (BSSO)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomly assigned to one of two groups. 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. 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.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The participant will not know which anesthetic they received on each side of their jaw. The care provider, who will be administering the anesthetic intraoperatively, will know which anesthetic is being administered on each side of the participant's jaw. The outcomes assessor will not know which anesthetics was administered on each side of the participant's jaw.

Study Groups

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Bupivacaine Left, Lidocaine Right

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 Type ACTIVE_COMPARATOR

10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine

Intervention Type DRUG

Injection of 10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine.

6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine

Intervention Type DRUG

Injection of 6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine.

Bupivacaine Right, Lidocaine Left

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.

Group Type ACTIVE_COMPARATOR

10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine

Intervention Type DRUG

Injection of 10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine.

6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine

Intervention Type DRUG

Injection of 6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine.

Interventions

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10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine

Injection of 10 cc of 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine.

Intervention Type DRUG

6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine

Injection of 6.8 cc of 2% lidocaine hydrochloride with 1:100,000 epinephrine.

Intervention Type DRUG

Other Intervention Names

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Bupivacaine Lidocaine

Eligibility Criteria

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Inclusion Criteria

* Undergoing an orthognathic procedure at Boston Children's Hospital
* Between the ages of 15 and 35 years old

Exclusion Criteria

* Any patient undergoing any other procedures in addition to their orthognathic procedure during the same sedation period (extraction, bone graft, etc.).
* Any patient with a history of chronic pain.
* Any patient with a history of an allergic reaction to bupivacaine or lidocaine.
* Any patient with known neurologic changes to the lip or chin.
* Any patient not enrolled in an Enhanced Recovery After Surgery (ERAS) Protocol.
* Any patient known to be pregnant or with a positive pregnancy test prior to the procedure.
Minimum Eligible Age

15 Years

Maximum Eligible Age

35 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Boston Children's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Mark Green

Oral and Maxillofacial Surgeon

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mark A Green, DDS, MD

Role: PRINCIPAL_INVESTIGATOR

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

Locations

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Boston Children's Hospital

Boston, Massachusetts, United States

Site Status

Countries

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United States

Related Links

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https://www.ncbi.nlm.nih.gov/books/NBK11858/

Bader JD, Bonito AJ, Shugars DA. Cardiovascular Effects of Epinephrine in Hypertensive Dental Patients: Summary.

Other Identifiers

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IRB-P00047452

Identifier Type: -

Identifier Source: org_study_id