Comparison of the Anesthetic Efficiency of Lidocaine and Tramadol Hydrochloride in Orthodontic Extractions: A Split-Mouth, Prospective, Randomized, Double-Blind Study

Purpose: The aim of the present randomized controlled split-mouth clinical study was to evaluate and compare the clinical anesthetic efficacy of lidocaine and tramadol hydrochloride in orthodontic extractions. Materials and Methods: A total of 32 systemically healthy patients requiring bilaterally maxillary first premolar extractions for orthodontic reasons were included. Each patient received 1.8 mL of lidocaine (36 mg lidocaine HCI and 0.0225 mg epinephrine) on 1 side and 1.8 mL tramadol (50 mg tramadol HCl and 0.0225 mg epinephrine diluted to 1.8 mL by distilled water) on the other side. The anesthetic solutions were infiltrated into the buccal vestibule (local infiltration) based on a computer-generated list. In each patient, the time of anesthetic onset and finish, anesthetic activity, duration of postoperative analgesia, additional analgesic medication, wound healing, possible side effects, and satisfaction levels were recorded intraoperatively and postoperatively for both sides. Results: Although no relevant differences were found between the solutions for anesthetic onset, lidocaine was significantly more effective statistically for the total anesthesia duration. Comparing the anesthetic activity at 5 minutes before extraction, we found that tramadol was significantly more effective statistically compared with lidocaine. Similarly, tramadol was significantly more effective statistically than lidocaine for satisfaction level and wound healing. Moreover, compared with tramadol, in terms of postoperative pain, the visual analog scale scores with lidocaine were significantly higher at statistically 7, 8, 9, and 10 hours during the first 12 hours. In general, the lidocaine values were dramatically higher than were the tramadol values. Conclusions: The results of the present study suggest that using tramadol combined with epinephrine can be an alternative local anesthetic for maxillary first premolar tooth extractions in oral-maxillofacial surgery. (C) 2019 American Association of Oral and Maxillofacial Surgeons