Bilateral block: is it safe and more efficient during removal of third molars?

Objective — to assess the safety, acceptability, and efficacy of removing bilaterally impacted wisdom teeth as a one-stage rather than a two-stage procedure. Design — randomised controlled trial. Setting — district hospital. Subjects —100 consecutive patients who required removal of bilaterally impacted third molars. Interventions — 50 patients were randomised to have the teeth removed in two stages, 3–4 weeks apart, the other 50 to have the teeth removed at one visit. All operations were done under local anaesthetic (2% lignocaine and 1/80 000 adrenaline) and intravenous midazolam 0.07–0.13 mg/kg titrated against sedative effect individually. Main outcome measures - morbidity, time off work, anxiety scores (assessed by visual analogue scale), and patient opinions. Results — 5 patients were withdrawn because they were not given the randomised treatment, and 10 were lost to follow-up, leaving 40 in the two-stage group and 45 in the one-stage group for analysis. Two patients in the one stage group developed SaO2 of less than 90% which was corrected by deep breathing, and another had a temporary parasthesia of the inferior alveolar nerve that resolved within a week. One patient in the two stage group had a haemorrhage after the first stage that required packing of the socket in the emergency department, and this patient refused to have the second tooth removed. The mean number of days taken off work was significantly less in the one stage group (mean 3 days compared with 5 days (P<0.005), and the anxiety scores did not differ significantly between the two groups. A quarter of the patients in the two-stage group would have preferred a one-stage procedure, but none in the one-stage group would have preferred a two-stage operation. Conclusions — removal of bilaterally impacted wisdom teeth under local anaesthesia and sedation in one session is safe, cost effective and acceptable to patients.