Comparative Analysis of Lidocaine vs. Bupivacaine for Local Anesthesia in Minor Surgical Procedures: A Meta-Analysis
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/097Keywords:
Lidocaine, Bupivacaine, Anesthesia, Local, Minor Surgical ProceduresAbstract
Background: Local anesthetics such as lidocaine and bupivacaine are the most commonly employed in simple surgical operations, but their relative efficacy is controversial. This systematic review and meta-analysis aimed to perform a comparative analysis of the local anesthesia agents, lidocaine and bupivacaine in minor surgical operations. This review was aimed at facilitating evidence-based clinical decision-making in the choice of the most effective anesthetic to use when applying minor surgical practice.
Methods: A search for lidocaine versus bupivacaine in minor surgical procedures was conducted in PubMed, Scopus, Web of Science, and Google Scholar for randomized controlled trials (RCTs). The studies were filtered in accordance with PRISMA 2020 criteria. The Cochrane tool was used to measure risk of bias, and the certainty of evidence was measured with GRADE. RevMan 5.4.1 was used to perform meta-analyses through random-effects models, subgroup and sensitivity analyses to test the robustness.
Results: 12 RCTs were included. Quantitative data on onset were available in eleven studies, and duration in seven. No statistically significant difference in onset between lidocaine and bupivacaine was observed in a pooled analysis (SMD -0.27; 95% CI -0.70 to 0.16; I2 =92%). Contrarily, duration of anesthesia preferred bupivacaine (SMD -2.47; 95% CI: -3.16 to -1.79; I2 = 85%), and the findings were strong regardless of sensitivity analyses. The risk of bias was low-to medium-moderate, and the general evidence certainty was moderate.
Discussion: Lidocaine has a better onset, and bupivacaine, a better analgesia, which validates their complementary roles in clinical indications. The two agents were safe, and intertrial heterogeneity demonstrates the necessity of standard protocols and multicenter, large-scale studies that could help guide an evidence-based anesthetic choice in the minor surgery practice.
References
1. Janev N, Ouanounou A. Local anesthetics in oral and maxillofacial medicine: pharmacology, adverse effects, drug interactions and clinical manifestations. J Oral Maxillofac Anesth 2024;3(1). doi:10.21037/joma-23-27
2. Nestor CC, Ng C, Sepulveda P, Irwin MG. Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review. Anaesthesia 2022;77(3):339–50. doi:10.1111/anae.15641
3. R S, T S, Rajadurai D, Parthasarathy S. Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial. Reg Anesth Pain Med 2023. doi:10.1136/rapm-2023-104542
4. Tripodi VF, Sardo S, Ippolito M, Cortegiani A. Effectiveness and safety of opioid-free anesthesia compared to opioid-based anesthesia: a systematic review and network meta-analysis. J Anesth Analg Crit Care 2025;5:53. doi:10.1186/s44158-025-00272-9
5. Sponheuer K, Becker-Rux D, Scheike S, Barsch L, Pempe C, Pfrepper C, et al. Impact of anesthesia type on postoperative pain and outcomes in primary hip and knee arthroplasty: a retrospective register analysis. BMC Anesthesiol 2025;25:274. doi:10.1186/s12871-025-03127-6
6. Abbi P, Gupta R, Kaur H, Aggarwal S. Comparing duration of analgesia after intrathecal administration of opioids in primary paturients for lower segment cesarean section. Anesth Essays Res 2021;15(3):327–31. doi:10.4103/aer.aer_135_21
7. Jaber EK, Amine EM, Mounir K, Hicham K, Ahmed HM, Jaouad L. Comparison between two mixtures of lidocaine and bupivacaine for infraclavicular block: a double blind randomized trial. Int Surg J 2020;7(5):1342–6. doi:10.18203/2349-2902.isj20201844
8. Gupta M, Patel SG, Kumar A, Jyothsna E, Garg N, Tiwari R, et al. Comparative study of different anesthetic agents on patient outcomes during pain management therapy: a comparative study. Eur J Cardiovasc Med 2021;11:79–82. doi:10.5083/ejcm/21
9. Su N, Wang H, Zhang S, Liao S, Yang S, Huang Y. Efficacy and safety of bupivacaine versus lidocaine in dental treatments: a meta-analysis of randomised controlled trials. Int Dent J 2020;64(1):34–45. doi:10.1111/idj.12060
10. Tsai SHL, Yolcu YU, Hung SW, Kurian SJ, Alvi MA, Fu TS, et al. The analgesic effect of intravenous lidocaine versus intrawound or epidural bupivacaine for postoperative opioid reduction in spine surgery: a systematic review and meta-analysis. Clin Neurol Neurosurg 2021;201:106438. doi:10.1016/j.clineuro.2020.106438
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi:10.1136/bmj.n71
12. Mishra A, Mahajan M, Bande C, Joshi A, Gawande M, Gupta MK. Is amalgamated ligno-bupivacaine an answer to complicated minor oral surgical anesthesia? a randomized split-mouth double-blind clinical trial. Oral Maxillofac Surg 2018;22(1):97–104. doi:10.1007/s10006-018-0676-z
13. Tirumalasetty SSM, Chinniswami Doraisami D, Konathala SVR, Penmetsa SG, Gottumukkala NVSSS. Comparison of efficacy and pain perception using 0.5% bupivacaine and 2% lidocaine in periodontal surgery—a split mouth randomized clinical trial. Eur Oral Res 2021;55(3):139–45. doi:10.26650/eor.2021853507
14. Lai F, Sutton B, Nicholson G. Comparison of l-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia. Br J Anaesth 2003;90(4):512–4. doi:10.1093/bja/aeg097
15. Maben D, Suresh A, Desai AK, Shetty S, Juturu U, Anand J. Efficacy of lidocaine vs combination of lidocaine and bupivacaine in management of maxillofacial trauma: a clinical comparative study. Clin Oral Investig 2023;27:6613–7. doi:10.1007/s00784-023-05267-w
16. Velioglu O, Calis AS, Koca H, Velioglu E. Bupivacaine vs. lidocaine: a comparison of local anesthetic efficacy in impacted third molar surgery. Clin Oral Investig 2020;24:3539–46. doi:10.1007/s00784-020-03224-5
17. Jongkongkawutthi R, Rungwattanakit P, Halilamien P, Poolsuppasit S, Sirivanasandha B. Comparison between bupivacaine-lidocaine, dexamethasone mixture and bupivacaine alone for motor recovery after axillary brachial plexus block in distal radius surgery: a prospective randomized trial. PLoS One 2025;20(4):e0321087. doi:10.1371/journal.pone.0321087
18. Van Boxstael S, Lopez AM, Balocco AL, Vandepitte C, Meex I, Duerinckx J, et al. Effect of lidocaine 2% versus bupivacaine 0.5% and 1 versus 2 dual separate injections on onset and duration of ultrasound-guided wrist blocks: a blinded 2 × 2 factorial randomized clinical trial. Anesth Analg 2022;134(6):1318–25. doi:10.1213/ANE.0000000000005936
19. Sedighinejad A, Naderi Nabi B, Ettehad H, Mirbolook A, Atrkarroushan Z, Ghazanfar Tehran S, et al. Does adding lidocaine to intrathecal bupivacaine affect hemodynamic parameters during hip fracture surgery? Arch Bone Jt Surg 2018;6(5):390–6.
20. Chen P, Smith H, Vinciullo C. Bupivacaine as an adjunct to lidocaine in Mohs micrographic surgery: a prospective randomized controlled trial. Dermatol Surg 2018;44(5):607–10. doi:10.1097/DSS.0000000000001385
21. Gunjiyal MS, Mohammed S, Bhatia P, Chhabra S, Kumar M, Sharma A. Effect of combined versus sequential injection of 2% lidocaine and 0.5% bupivacaine on the onset and duration of supraclavicular brachial plexus block: a double blinded randomised controlled trial. J Clin Anesth 2021;72:110313. doi:10.1016/j.jclinane.2021.110313
22. Samal S, Jena S, Mishra J, Nanda P, Biswal D. Evaluation of efficacy of peribulbar block with the combination of 2% lidocaine and 0.5% bupivacaine in comparison with 2% lidocaine and 0.75% ropivacaine in cataract surgery. Natl J Maxillofac Surg 2023;14(2):300–4. doi:10.4103/njms.njms_100_22
23. Pongraweewan O, Inchua N, Kitsiripant C, Kongmuang B, Tiwirach W. Onset time of 2% lidocaine and 0.5% bupivacaine mixture versus 0.5% bupivacaine alone using ultrasound and double nerve stimulation for infraclavicular brachial plexus anesthesia in ESRD patients undergoing arteriovenous fistula creation. J Med Assoc Thai 2016;99(5):589–95.
24. Wang J, Bian Q, Chen X, Feng Y, Zhang L, Chen P. The mechanism of perioperative intravenous lidocaine in regulating the inflammatory response: a review. Medicine (Baltimore) 2024;103:e39574. doi:10.1097/MD.0000000000039574
25. Qin J, Lei Z, Li R, Zhou Y, Zhong Y. Intrapleural injection of bupivacaine liposome for pain management after thoracoscopic surgery. Sci Rep 2025;15:24433. doi:10.1038/s41598-025-10616-8
26. Wiedmer SK, Sohn JT. Lipophilicity of drugs, including local anesthetics, and its association with lipid emulsion resuscitation. Korean J Anesthesiol 2024;77:170–2. doi:10.4097/kja.23825
27. Small A, Fetiveau M, Smith R, Colditz I. Three studies evaluating the potential for lidocaine, bupivacaine or procaine to reduce pain-related behaviors following ring castration and/or tail docking in lambs. Animals 2021;11:3583. doi:10.3390/ani11123583
28. Fu G, Xu L, Chen H, Lin J. State-of-the-art anesthesia practices: a comprehensive review on optimizing patient safety and recovery. BMC Surg 2025;25:32. doi:10.1186/s12893-025-02763-6
29. Romano G, Di Buono G, Rodolico V, Romano G, Barletta G, Zanghì G, et al. The DySLOH study: comparative evaluation of the results between the ProFlor and Lichtenstein techniques for open inguinal hernia repair—a randomized controlled trial. J Clin Med 2024;13:5530. doi:10.3390/jcm13185530
30. Mansour-Ghanaei M, Hosseinzadeh F, Sharami SH, Biazar G, Noori F, Asgari-Ghalebin SM. Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: a double-blind clinical trial. Health Sci Rep 2022;5:e551. doi:10.1002/hsr2.551
31. Silva A, Mourão J, Vale N. A review of the lidocaine in the perioperative period. J Pers Med 2023;13:1699. doi:10.3390/jpm13121699
32. Jaffal K, Chevillard L, Mégarbane B. Lipid emulsion to treat acute poisonings: mechanisms of action, indications, and controversies. Pharmaceutics 2023;15:1396. doi:10.3390/pharmaceutics15051396
33. Long B, Chavez S, Gottlieb M, Montrief T, Brady WJ. Local anesthetic systemic toxicity: a narrative review for emergency clinicians. Am J Emerg Med 2022;59:42–8. doi:10.1016/j.ajem.2022.06.017
34. Whitehall KB, Rose S, Clague GE, Ahring KK, Bilder DA, Harding CO, et al. Systematic literature review of the somatic comorbidities experienced by adults with phenylketonuria. Orphanet J Rare Dis 2024;19:293. doi:10.1186/s13023-024-03203-z
35. Emanuel N, Kozloski GA, Nedvetzki S, Rosenfeld S. Potent antibacterial activity in surgical wounds with local administration of D-PLEX100. Eur J Pharm Sci 2023;188:106504. doi:10.1016/j.ejps.2023.106504
36. Koo CH, Shin HJ, Han SH, Ryu JH. Lidocaine vs other local anesthetics in the development of transient neurologic symptoms following spinal anesthesia: a meta-analysis of randomized controlled trials. J Clin Med 2020;9:493. doi:10.3390/jcm9020493
37. Liu S, Zhao P, Cui Y, Lu C, Ji M, Liu W, et al. Effect of 5-μg dose of dexmedetomidine in combination with intrathecal bupivacaine on spinal anesthesia: a systematic review and meta-analysis. Clin Ther 2020;42:676–90.e5. doi:10.1016/j.clinthera.2020.02.009
38. Vinyes D, Muñoz-Sellart M, Fischer L. Therapeutic use of low-dose local anesthetics in pain, inflammation, and other clinical conditions: a systematic scoping review. J Clin Med 2023;12:7221. doi:10.3390/jcm12237221
39. Jeong JO, Kim M, Kim S, Lee KK, Choi H. Advanced hydrogel systems for local anesthetic delivery: toward prolonged and targeted pain relief. Gels 2025;11:131. doi:10.3390/gels11020131
40. Meretsky CR, Plitt VE, Friday BL, Schiuma AT, Ajebli M. A comparative analysis of the efficacy of local anesthetics and systemic anesthetics in the red-headed versus non-red-headed patient population: a comprehensive review. Cureus 2024;16:e61797. doi:10.7759/cureus.61797
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
