(TC29) Use of Long-Acting Anesthetic for Managing Severe Odontogenic Pain: A Case Report

Pain management is crucial in endodontics, particularly in cases involving persistent pain. Persistent pain can lead to prolonged nerve activation, lowering the pain threshold and triggering exaggerated responses to painful or non-noxious stimuli, resulting in central sensitization. Long-acting anesthetics such as bupivacaine play a vital role in managing pain during the acute post-operative period. Bupivacaine, an amide local anesthetic, achieves anesthesia by blocking nerve impulse generation and conduction. Notably, it provides prolonged analgesia that can extend beyond its half-life, as supported by medical literature. 

This table clinic aims to present a case report detailing the use of bupivacaine for managing severe odontogenic pain unresponsive to conventional analgesics. A 44-year-old immunocompetent female patient was referred to Harvard Dental Center for endodontic management of previously initiated treatment on tooth #31. The patient reported severe, persistent, and lingering pain (rated 10/10) and had been taking a combination of ibuprofen and acetaminophen every six hours for pain management, but this provided minimal relief. Given the limited time for endodontic intervention, the patient was offered a long-acting local anesthetic to alleviate her symptoms. The patient consented, and an inferior alveolar nerve block of 1.7mL of 0.5% bupivacaine with 1:200,000 epinephrine was administered. At the treatment visit, the patient reported complete relief of her symptoms and discontinued the use of analgesics. This case report highlights the use of long-acting local anesthetic as a viable alternative for managing severe odontogenic pain when other interventions are not immediately feasible, or as an adjunct to root canal treatment.