Surgical management of impacted mandibular third molars affects a region rich in blood supply and loose connective tissues, which commonly results in postoperative inflammatory reactions manifested as pain, edema, trismus, and temporary impairment of oral function. Within minor oral surgery, a comprehensive strategy to prolong anaesthetic action and lessen these unavoidable postoperative effects has not yet been thoroughly established. To assess whether incorporating dexamethasone into local anaesthetic solutions enhances the depth and duration of anaesthesia and decreases post-surgical complications following the extraction of impacted third molars. A controlled, randomized, split-mouth, double-blind prospective investigation was undertaken in 35 participants undergoing lower third molar removal. The experimental side (Group I) was administered 8 mg dexamethasone combined with 2 ml of 2% lignocaine with epinephrine, while the comparison side (Group II) received 2 ml sterile water added to 2 ml of 2% lignocaine with epinephrine. Measurements included onset and duration of anaesthesia, followed by assessments of pain, swelling, and mouth opening limitations across 7 postoperative days. Data were analyzed using independent t-tests and repeated-measures ANOVA. The dexamethasone group demonstrated a reduction in anaesthetic onset time by 69 s and an extension of duration by 128.4 min (p < 0.001). Pain levels during the initial 24 h (Visual Analogue Scale) were 4.9 versus 7.5 in the test and control groups, respectively (p < 0.001). Mean analgesic consumption through day 7 was 12.6 doses in Group I and 18.4 in Group II (p < 0.001). Postoperative swelling was markedly reduced in the dexamethasone group, and trismus was also diminished by 1 cm on days 1 and 2 and by 0.2 cm on day 7. Supplementing lignocaine with dexamethasone during nerve blockade accelerates the onset, prolongs anaesthetic duration, and significantly reduces pain, edema, and trismus. Direct incorporation of steroids into the local anaesthetic solution may substantially limit postoperative complications in third molar surgeries while requiring only a single injection.
