Efficacy of Ropivacaine with or without dexamethasone and Bupivacaine with or without dexamethasone for Local Anesthesia in open reduction and internal fixation of Mandible Fractures: A Triple-Blind Randomized Controlled Trial

Mandibular fractures, the second most common facial fractures after nasal fractures, often require open reduction and internal fixation (ORIF) for optimal anatomical and functional recovery. Effective intraoperative anesthesia and prolonged postoperative analgesia are crucial for patient comfort, reduced complications, and faster recovery. This triple-blind randomized controlled trial aims to compare the efficacy of ropivacaine (0.75%) and bupivacaine (0.5%), each with or without dexamethasone (4 mg/ml), in unilateral isolated mandibular fractures managed via ORIF. Thirty-two patients, meeting strict inclusion criteria and randomized into four equal groups, will undergo standardized local anesthesia techniques, including inferior alveolar, lingual, long buccal nerve blocks, and peri-incisional infiltration. Primary outcomes include intraoperative and postoperative pain scores (Visual Analogue Scale) and duration of analgesia, defined as the time to first rescue analgesic. Secondary outcomes include postoperative swelling (four-line measurement method), incidence of complications, safety profile, and surgical duration. Literature suggests that ropivacaine offers prolonged analgesia with less motor blockade, while bupivacaine, though potent, carries a higher cardiotoxicity risk. Dexamethasone, as an adjuvant, may further prolong analgesia by delaying systemic absorption and reducing inflammation. Data will be statistically analyzed to test the null hypothesis that dexamethasone addition yields no significant benefit over anesthetic alone. This study seeks to address the paucity of comparative evidence between ropivacaine–dexamethasone and bupivacaine–dexamethasone combinations in mandibular fracture surgery, potentially guiding clinicians toward optimal anesthetic protocols for improved patient outcomes, reduced analgesic consumption, and enhanced recovery.