1
|
Yang M, Li T, Wang H, Zhang Q, Yang H, Chi Y, Hou J. Effect of a Thermosensitive Hydroxybutyl Chitosan Hydrogel on Postoperative Sequalae and Quality of Life After Impacted Mandibular Third Molar Extraction. J Oral Maxillofac Surg 2024:S0278-2391(24)00574-3. [PMID: 38971179 DOI: 10.1016/j.joms.2024.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Third molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PURPOSE The study purpose was to measure and compare differences in pain, swelling, trismus, wound healing, and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. STUDY DESIGN, SETTING, SAMPLE This study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. PREDICTOR VARIABLE The predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiological saline) side. MAIN OUTCOME VARIABLE The primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening, were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. COVARIATES The covariates included age, sex, and operation time. ANALYSES The Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P < .05. RESULTS The study included 60 patients (mean age: 25.81 ± 4.91; 23 (38%) males, 37 (62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < .001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < .001), maximal incisional opening (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P < .001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P < .001), and swelling (6.86 ± 0.70 mm, 7.15 ± 0.80 mm, day 3, P = .006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ± 2.14, day 3, P < .001). CONCLUSION AND RELEVANCE The application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative QOL.
Collapse
Affiliation(s)
- Mingen Yang
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingyu Li
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Honghao Wang
- Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qianqian Zhang
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hao Yang
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yifan Chi
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Hou
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| |
Collapse
|
2
|
Golkar M, Taheri A, Alam M, Asadi Y, Keyhan SO. The effects of Kinesio tapes on facial swelling following bimaxillary orthognathic surgery in the supraclavicular region. Maxillofac Plast Reconstr Surg 2023; 45:22. [PMID: 37335425 DOI: 10.1186/s40902-023-00385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/19/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Several osteotomies are required for orthognathic surgery to reposition the jaws correctly. This study aimed to evaluate whether Kinesiotaping can reduce swelling, pain, and trismus following orthognathic surgery of the facial skull. MATERIALS AND METHODS The present study consists of two phases. In the split-mouth phase, 16 skeletal class III patients underwent Bimax Orthognathic surgery, and Kinesiological tape (KT) was applied on one half of the face. In the prospective case-control phase, 30 patients were divided into two groups. Kinesio tape was applied on both sides of the face of the Kinesio group, and pressure dressing and ice therapy were used for the second group. The tape was parallel to the lower border of the mandible along its entire length, tangent to the labial commissure area on the studied side. The tape was placed in place for 5 days. Edema was evaluated by measuring the distance from the menton to the lower edge of the tragus. The maximum mouth-opening trismus was evaluated, and the VAS index was used to evaluate pain. RESULTS There was evidence of swelling reduction after KT; within the same study, differences between the left and right sides as well as for the same side were statistically significant (p < 0.001). As a result of tapping lymphatic Kinesio tape on the affected area, tension was reduced, and lymphatic circulation was restored. Blood and lymph microcirculation was improved, enabling the body to heal itself. CONCLUSION Kinesio tape reduced swelling after orthognathic surgery in a positive way. As a simple, non-traumatic, economical method, Kinesio taping seems promising.
Collapse
Affiliation(s)
- Mohsen Golkar
- School of Dentistry, AJA University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anita Taheri
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasin Asadi
- Department of Periodontics, School of Dentistry, AJA University of Medical Sciences, Tehran, Iran.
| | - Seied Omid Keyhan
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea.
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA.
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation (www.Maxillogram.com), Tehran, Iran.
- Iface Academy, Marietta, GA, USA.
| |
Collapse
|
3
|
Gupta S, Gupta SK, Mittal A, Passi D, Goyal J. Effect of preoperative ibuprofen on pain after lower third molar removal: A randomized controlled trial. Natl J Maxillofac Surg 2023; 14:294-299. [PMID: 37661996 PMCID: PMC10474544 DOI: 10.4103/njms.njms_316_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/18/2021] [Accepted: 09/12/2021] [Indexed: 09/05/2023] Open
Abstract
Aim The aim of the study is to predict the effect of preemptive analgesics in the third molar surgery and to analyze whether the number and frequency of postoperative analgesics are reduced following the administration of preemptive analgesics. Materials and Methods The present study was carried out on 50 patients who reported to the Department of Oral and Maxillofacial Surgery for removal of their impacted mandibular third molar. The patients were randomly divided into two groups of 25 patients each - Group A (test group) patients receiving ibuprofen (400 mg) half an hour before the surgery and placebo half an hour after surgery and the Group B (control group) patients receiving placebo half an hour before the surgery and ibuprofen (400 mg) half an hour after surgery. Both groups of patients will be instructed to avoid any drug but those prescribed (ibuprofen 400 mg SOS and rescue medication of tramadol 50 mg SOS) and not to seek any medical help elsewhere for postoperative problems. The pain was recorded using a visual analog scale. Results Demographic data in the study show females (8%) and male (92%) patients. The average time taken for surgery was more in the control group (58.36 min) as compared to the test group (55.64 min) with no statistically significant difference. Values of pain score, medication score, number of rescue medication, and frequency at different time intervals (at baseline, after 3 h, 6 h, 24 h, and 7 days) are expressed in terms of mean and standard deviation, respectively, and the result shows the statistically significant difference for pain score at baseline and 7th-day time interval only. The distribution of different types of impaction and different types of elevation/odontotomy shows a significant association in test and control groups. Conclusion Preoperative ibuprofen decreases the frequency and intensity of the pain. We believe that since this preoperative ibuprofen seems to be beneficial without any adverse effects, it may be used routinely in the 3rd molar surgeries and even in routine extraction.
Collapse
Affiliation(s)
- Sameer Gupta
- Department of Oral and Maxillofacial Surgery, DJ College of Dental Sciences and Research, Ghaziabad, India
| | | | - Ankur Mittal
- Department of Oral and Maxillofacial Surgery, DJ College of Dental Sciences and Research, Ghaziabad, India
| | - Deepak Passi
- Department of Dentistry, CHC Mirzapur, Azamgarh, Uttar Pradesh, India
| | - Jyoti Goyal
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|
4
|
Agarwal N, Nelson M, Mishra S, Agarwal P, Sharma D. Effectiveness of adhesive taping to reduce pain, swelling and trismus after fracture mandible surgery. Trop Doct 2023; 53:121-124. [PMID: 36423249 DOI: 10.1177/00494755221140623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Swelling, pain and trismus constitute the major post-operative morbidity after surgery for mandibular fractures. We assessed the role of kinesio taping in mitigating these. Two groups of 15 patients were compared; those who had such applied to the side of the fracture and a control group of those who did not. Pain, swelling and trismus were assessed pre-operatively, and on the second, third and fifth post-operative days, and found to be significantly less in the study group. This simple technique is therefore effective. It is a simple frugal intervention without any side effects.
Collapse
Affiliation(s)
- Namrata Agarwal
- Resident, 534313Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India
| | - Meenal Nelson
- Resident, 534313Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India
| | - Shrivats Mishra
- Resident, 534313Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India
| | - Pawan Agarwal
- Professor and in Charge, Plastic Surgery Unit, 534313Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India
| | - Dhananjaya Sharma
- Professor and Head, 534313Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India
| |
Collapse
|
5
|
Bhushan K, Sharma ML. Kinesiologic Tape on Post Operative Swelling, Pain, Trismus in Zygomatico-Maxillary Complex Fracture after Orif: A Changing Tactics. Indian J Otolaryngol Head Neck Surg 2022; 74:4795-4801. [PMID: 36742730 PMCID: PMC9895162 DOI: 10.1007/s12070-022-03081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/01/2022] [Indexed: 02/07/2023] Open
Abstract
There has been always a need of new methods to control post operative complications in OMFS. A randomized prospective study was done to assess the effect of K tape on postoperative swelling, pain, trismus in Zygomatico-maxillary Complex (ZMC) fracture after open reduction with internal fixation using two point fixation. 30 patients of either gender undergoing ORIF for ZMC fracture using two point fixation of age group between 18 and 50 years were included in the study. Patients were divided into treatment either with or without Kinesiologic tape. Tape was applied directly after surgery and maintained for at least 5 days postoperatively. Facial swelling was quantified using a five-line measurement at six specific points of time. Pain and degree of mouth opening was measured. Patient's subjective feeling was asked. The values were subjected to Fischer's exact test, Independent sample test, Mann whitney U test, Wilocoxon sign rank test. The results of this study show that application of Kinesiologic tape after zygomatico maxillary complex fracture surgery significantly reduced the incidence of swelling with an earlier resolution of swelling, and decreased the maximum turgidity for more than 60% during the first 2 days after surgery. Although, Kinesiologic tape has no significant influence on pain control but reduction in trismus in the Kinesiologic tape group compared to the non-Kinesiologic tape group. Furthermore, patients with Kinesiologic tape felt significantly lower morbidity than those without Kinesiologic tape. This study suggests that Kinesiologic tape is a promising, simple, less traumatic, economical approach, which is free from adverse reaction and improves patients quality of life.
Collapse
|
6
|
Ramos EU, Benetti LP, Oliveira JCS, Bassi APF. Single-Dose Ibuprofen-Arginine as a Preventive for Pain, Edema, and Trismus After Impacted Lower Third Molar Surgery: A Randomized Split-Mouth Clinical Trial. Eur J Dent 2021; 16:396-402. [PMID: 34937107 PMCID: PMC9339938 DOI: 10.1055/s-0041-1735910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective
We examined if the association of ibuprofen with arginine has a better anti-inflammatory effect on pain, edema, and trismus after surgery of the impacted mandibular third molar than ibuprofen alone.
Materials and Methods
The study included 21 patients, 18 to 30 years of age, each with an impacted, and bilateral and symmetric third molar (total
n
= 21) that required transalveolar extraction. Patients were randomly assigned numbers from 1 to 21. Group A received ibuprofen-arginine as preoperative medication, while Group B received only ibuprofen. Both groups received the same postoperative medications: amoxicillin + acetaminophen. All patients were evaluated for pain at 6, 12, and 24 hours. They were evaluated for edema and trismus before surgery; immediately after surgery; and at 24, 48, and 72 hours postoperatively. Postoperative pain scores used the visual analog scale (BS-11). For facial edema and trismus, linear measurements used the method modified by Gabka and Matsumura.
Statistical Analysis
For the evaluation of data between Group A and Group B, we used the statistical software SPSS version 22. The Shapiro-Wilk, analysis of variance, the Bonferroni comparisons, and the Wilcoxon test were used. All tests were based on a significance level of 0.05.
Results
The study results reveal that the facial edema scores of Group A and Group B presented statistically significant differences (
p
< 0.05), while for postoperative trismus, there was no statistically significant difference (
p
> 0.05) between the scores of Group A and Group B.
Conclusion
As a conclusion, we can state that the use of ibuprofen-arginine allows for significantly better control of pain and edema, and shows a tendency toward better recovery from trismus, although without statistical significance. Based on this, we can assert that arginine improves the anti-inflammatory power of ibuprofen, thus generating better tissue healing after surgery of the impacted third molar.
Collapse
Affiliation(s)
- Edith Umasi Ramos
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | - Luan Pier Benetti
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | - Júlio César Silva Oliveira
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | - Ana Paula Farnezi Bassi
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| |
Collapse
|
7
|
Mattos-Pereira GH, Martins CC, Esteves-Lima RP, Alvarenga-Brant R, Cota LO, Costa FO. Preemptive analgesia in dental implant surgery: A systematic review and meta-analysis of randomized controlled trials. Med Oral Patol Oral Cir Bucal 2021; 26:e632-e641. [PMID: 34415001 PMCID: PMC8412441 DOI: 10.4317/medoral.24639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022] Open
Abstract
Background To assess the effectiveness of preemptive analgesia in dental implant surgery in randomized controlled trials (RCTs). Material and Methods The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in PROSPERO database CRD42020168757. A search without restrictions regarding language or date of publication was conducted in six databases and gray literature. A random effect meta-analysis compared the efficacy of preemptive analgesia compared to placebo through pooled OR and 95%CI. The interpretation of results followed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach together with the magnitude of the effect according to GRADE guidelines. Results Four studies were included in the review and three were incorporated into the meta-analysis. All studies demonstrated that preemptive analgesia contributed to a significant improvement in the postoperative pain control. However, the overall pooled standard mean difference (SMD) showed that preemptive analgesia had small effects compared to placebo in reducing pain (SMD: -0.45; IC: -0.83; -0.08) with low certainty of the evidence. Our meta-analysis showed that the magnitude of the effect was bigger six to eight hours after the surgery (large effect), compared to the time of one to two hours after the surgery (small effect). Conclusions Preemptive analgesia may have a positive effect in reducing pain compared to not using preemptive medication, but the evidence is very uncertain. Key words:Preemptive analgesia, postoperative pain, dental implant surgery, systematic review.
Collapse
Affiliation(s)
- G-H Mattos-Pereira
- Antônio Carlos Ave., 6627 Pampulha, Belo Horizonte, MG Zip code: 31270-901, Brazil
| | | | | | | | | | | |
Collapse
|
8
|
Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, Lund JN, Williams JP. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev 2021; 6:CD012978. [PMID: 34125958 PMCID: PMC8203105 DOI: 10.1002/14651858.cd012978.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postoperative pain is a common consequence of surgery and can have many negative perioperative effects. It has been suggested that the administration of analgesia before a painful stimulus may improve pain control. We defined pre-emptive nonsteroidal anti-inflammatories (NSAIDs) as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. OBJECTIVES To assess the efficacy of preventive and pre-emptive NSAIDs for reducing postoperative pain in adults undergoing all types of surgery. SEARCH METHODS We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED and CINAHL (up to June 2020). In addition, we searched for unpublished studies in three clinical trial databases, conference proceedings, grey literature databases, and reference lists of retrieved articles. We did not apply any restrictions on language or date of publication. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs) only. We included adult participants undergoing any type of surgery. We defined pre-emptive NSAIDs as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. We included studies that gave the medication by any route but not given on the skin. DATA COLLECTION AND ANALYSIS We used the standard methods expected by Cochrane, as well as a novel publication bias test developed by our research group. We used GRADE to assess the certainty of the evidence for each outcome. Outcomes included acute postoperative pain (minimal clinically important difference (MCID): 1.5 on a 0-10 scale), adverse events of NSAIDs, nausea and vomiting, 24-hour morphine consumption (MCID: 10 mg reduction), time to analgesic request (MCID: one hour), pruritus, sedation, patient satisfaction, chronic pain and time to first bowel movement (MCID: 12 hours). MAIN RESULTS We included 71 RCTs. Seven studies are awaiting classification. We included 45 studies that evaluated pre-emptive NSAIDs and 26 studies that evaluated preventive NSAIDs. We considered only four studies to be at low risk of bias for most domains. The operations and NSAIDs used varied, although most studies were conducted in abdominal, orthopaedic and dental surgery. Most studies were conducted in secondary care and in low-risk participants. Common exclusions were participants on analgesic medications prior to surgery and those with chronic pain. Pre-emptive NSAIDs compared to post-incision NSAIDs For pre-emptive NSAIDs, there is probably a decrease in early acute postoperative pain (MD -0.69, 95% CI -0.97 to -0.41; studies = 36; participants = 2032; I2 = 96%; moderate-certainty evidence). None of the included studies that reported on acute postoperative pain reported adverse events as an outcome. There may be little or no difference between the groups in short-term (RR 1.00, 95% CI 0.34 to 2.94; studies = 2; participants = 100; I2 = 0%; low-certainty evidence) or long-term nausea and vomiting (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 228; I2 = 29%; low-certainty evidence). There may be a reduction in late acute postoperative pain (MD -0.22, 95% CI -0.44 to 0.00; studies = 28; participants = 1645; I2 = 97%; low-certainty evidence). There may be a reduction in 24-hour morphine consumption with pre-emptive NSAIDs (MD -5.62 mg, 95% CI -9.00 mg to -2.24 mg; studies = 16; participants = 854; I2 = 99%; low-certainty evidence) and an increase in the time to analgesic request (MD 17.04 minutes, 95% CI 3.77 minutes to 30.31 minutes; studies = 18; participants = 975; I2 = 95%; low-certainty evidence). There may be little or no difference in opioid adverse events such as pruritus (RR 0.40, 95% CI 0.09 to 1.76; studies = 4; participants = 254; I2 = 0%; low-certainty evidence) or sedation (RR 0.51, 95% CI 0.16 to 1.68; studies = 4; participants = 281; I2 = 0%; low-certainty evidence), although the number of included studies for these outcomes was small. No study reported patient satisfaction, chronic pain or time to first bowel movement for pre-emptive NSAIDs. Preventive NSAIDs compared to post-incision NSAIDs For preventive NSAIDs, there may be little or no difference in early acute postoperative pain (MD -0.14, 95% CI -0.39 to 0.12; studies = 18; participants = 1140; I2 = 75%; low-certainty evidence). One study reported adverse events from NSAIDs (reoperation for bleeding) although the events were low which did not allow any meaningful conclusions to be drawn (RR 1.95; 95% CI 0.18 to 20.68). There may be little or no difference in rates of short-term (RR 1.26, 95% CI 0.49 to 3.30; studies = 1; participants = 76; low-certainty evidence) or long-term (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 456; I2 = 29%; low-certainty evidence) nausea and vomiting. There may be a reduction in late acute postoperative pain (MD -0.33, 95% CI -0.59 to -0.07; studies = 21; participants = 1441; I2 = 81%; low-certainty evidence). There is probably a reduction in 24-hour morphine consumption (MD -1.93 mg, 95% CI -3.55 mg to -0.32 mg; studies = 16; participants = 1323; I2 = 49%; moderate-certainty evidence). It is uncertain if there is any difference in time to analgesic request (MD 8.51 minutes, 95% CI -31.24 minutes to 48.27 minutes; studies = 8; participants = 410; I2 = 98%; very low-certainty evidence). As with pre-emptive NSAIDs, there may be little or no difference in other opioid adverse events such as pruritus (RR 0.56, 95% CI 0.09 to 3.35; studies = 3; participants = 211; I2 = 0%; low-certainty evidence) and sedation (RR 0.84, 95% CI 0.44 to 1.63; studies = 5; participants = 497; I2 = 0%; low-certainty evidence). There is probably little or no difference in patient satisfaction (MD -0.42; 95% CI -1.09 to 0.25; studies = 1; participants = 72; moderate-certainty evidence). No study reported on chronic pain. There is probably little or no difference in time to first bowel movement (MD 0.00; 95% CI -15.99 to 15.99; studies = 1; participants = 76; moderate-certainty evidence). AUTHORS' CONCLUSIONS There was some evidence that pre-emptive and preventive NSAIDs reduce both pain and morphine consumption, although this was not universal for all pain and morphine consumption outcomes. Any differences found were not clinically significant, although we cannot exclude this in more painful operations. Moreover, without any evidence of reductions in opioid adverse effects, the clinical significance of these results is questionable although few studies reported these outcomes. Only one study reported clinically significant adverse events from NSAIDs administered before surgery and, therefore, we have very few data to assess the safety of either pre-emptive or preventive NSAIDs. Therefore, future research should aim to adhere to the highest methodology and be adequately powered to assess serious adverse events of NSAIDs and reductions in opioid adverse events.
Collapse
Affiliation(s)
- Brett Doleman
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - Thomas P Heinink
- Department of Anaesthesia, Frimley Health NHS Foundation Trust, Frimley Park Hospital, Frimley, UK
| | - Hannah Boyd-Carson
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Laura Carrick
- Department of Anaesthesia and Intensive care, Royal Derby Hospital, Derby, UK
| | - Rahil Mandalia
- Department of Anaesthesia, University Hospitals of Leicester, Leicester, UK
| | - Jon N Lund
- Division of Health Sciences, School of Medicine, University of Nottingham, Derby, UK
| | - John P Williams
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| |
Collapse
|
9
|
Efficacy of serratiopeptidase after impacted third molar surgery: a randomized controlled clinical trial. BMC Oral Health 2021; 21:91. [PMID: 33653320 PMCID: PMC7927242 DOI: 10.1186/s12903-021-01451-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serratiopeptidase has been clinically used in controlling surgical and non-surgical inflammatory conditions. This study was conducted to assess the therapeutic effect of Serratiopeptidase in patients undergoing surgical removal of impacted mandibular third molar. METHODS This randomized clinical trial investigated the efficacy of Serratiopeptidase and Paracetamol after surgical removal of impacted third molar for 5 days (n = 67) as compared with an equivalent dose of placebo and Paracetamol (n = 66). Outcome measures were reported pain, trismus and swelling using Laskin method. All outcome measures were recorded on days 0, 1, 2, 4, and 5 post-surgeries. RESULTS In this clinical trail 133 patients (mean age 23 years, 54% female) completed the study. Baseline characteristics were comparable across treatment groups. Serratiopeptidase significantly improved trismus compared with control on the 4th day (27.30 ± 7.3 mm and 32.06 ± 7.7 mm, respectively (P < 0.001) Swelling markedly improved, The distance from the lower edge of the earlobe to the midpoint of the symphysis for cases vs control were 111.49 ± 8.1 mm and 115.39 ± 9.9 mm, respectively (P < 0.001). Reported pain, showed no statistical significance difference. CONCLUSION Serratiopeptidase resulted in better inflammation improvement than placebo over 5 days. Further studies are warranted to assess longer-term and clinical outcomes, as well as safety. CLINICAL RELEVANCE Serratiopeptidase administered postoperatively helps in improving trismus and swelling after removal of impacted lower third molars. Trial registration The study was registered in ClinicalTrial.gov under the number NCT02493179. Registered 1st of June 2015, https://clinicaltrials.gov/ct2/results?cond=serratiopeptidase .
Collapse
|
10
|
Silva LD, Reis EN, Faverani LP, Farnezi Bassi AP. The efficacy of etodolac and ibuprofen, regarding gender, on pain, edema and trismus after impacted lower third molar surgery: A randomized prospective clinical split-mouth study. Med Oral Patol Oral Cir Bucal 2021; 26:e136-e140. [PMID: 33037801 PMCID: PMC7980292 DOI: 10.4317/medoral.24082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/28/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aimed to conduct a randomized prospective study about the efficacy of etodolac and ibuprofen on trismus, pain and edema regarding gender of patients submitted to impacted lower third molar teeth extraction. MATERIAL AND METHODS Thirty patients aging between 16 and 35 year-old were submitted to the exodontia of impacted lower third molars. During the postoperative period, patients received nine ibuprofen (600 mg) or etodolac (300 mg) pills via oral administration immediately after surgery and repeated doses every eight hours during three days. Patients were evaluated regarding pain, trismus and edema. RESULTS Sixteen men and fourteen women participated of the study. No statistical difference was established regarding gender according to the evaluated parameters. However, etodolac use showed better results regarding pain, trismus and edema. CONCLUSIONS Pain, edema and trismus after impacted third molars extraction were not influenced by gender.
Collapse
Affiliation(s)
- L-D Silva
- José Bonifácio street number 1193 16015-050, Araçatuba, São Paulo, Brazil
| | | | | | | |
Collapse
|
11
|
Santos BFE, Costa FO, Pinto Júnior AAC, Araújo AVA, Cyrino RM, Cota LOM. Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial. J Craniomaxillofac Surg 2021; 49:694-704. [PMID: 33994294 DOI: 10.1016/j.jcms.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
This randomized controlled clinical trial aimed to evaluate the preemptive effects of acetaminophen, ibuprofen, ketoprofen, nimesulide or dexamethasone on postoperative pain and edema in the surgical removal of impacted third molars. Participants underwent bilateral surgeries at 2 different times and were randomly given the test drug or placebo (split-mouth). Postoperative pain, edema and rescue medication were evaluated at different times. Study power was >80% for the observed effect size in the crossover repeated measures design. Differences between test drug and placebo were the response variable. Generalized Estimation Equation models were adjusted for each outcome. Sample comprised 5 groups (n = 20 each). Ibuprofen and nimesulide showed higher overall effects on pain scores over time, with no differences between them (p = 0.557). Acetaminophen showed significantly lower overall effects in edema control over time, when compared to other test drugs, that showed similar effects. Lower quantity of rescue medication were also observed for ibuprofen and nimesulide, with no differences between them (p = 0.999). Ibuprofen and nimesulide showed beneficial overall preemptive effects. Hence, in the decision-making process for preemptive analgesia in impacted third molar surgeries, ibuprofen and nimesulide should be considered on a case-by-case basis as the drugs of choice.
Collapse
Affiliation(s)
- Bianca Fernanda Espósito Santos
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Renata Magalhães Cyrino
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís Otávio Miranda Cota
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
12
|
Anehosur V, Krishnamurthy K, Radder K. The influence of kinesiology tape on postoperative edema, pain, and trismus in zygomaticomaxillary fracture. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_40_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Kano K, Kawamura K, Miyake T. Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective, single-blind, randomized controlled trial. Med Oral Patol Oral Cir Bucal 2021; 26:e64-e70. [PMID: 33037803 PMCID: PMC7806347 DOI: 10.4317/medoral.23983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/17/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The efficacy of preemptive analgesia in managing postoperative pain remains controversial. The aim of this study was to compare the efficacy of intravenous (IV) acetaminophen administered before or immediately after the surgical extraction of an impacted mandibular third molar. MATERIAL AND METHODS This prospective randomized clinical trial included 120 patients. The patients were assigned to one of three groups: the preoperative-treatment group (pre-group), which received 1000 mg of IV acetaminophen 20 min before surgery; the postoperative-treatment group (post-group), which received 1000 mg of IV acetaminophen after surgery; the no-treatment group (control-group), which did not receive any analgesic. Rescue analgesic (60 mg loxoprofen) was issued to each patient, with instructions on self-administration if needed. For the rescue medication usage, the time of first loxoprofen usage and the total amount of loxoprofen consumption were obtained for a 17-hour period after surgery. We measured pain using the visual analogue scale at 1 hour and at 2, 3, 4, 5, and 15 hours after surgery. RESULTS There was no significant difference in pain level among the three groups at any time interval. However, the pre-group demonstrated significantly lower rescue analgesic consumption and longer time until initial administration. CONCLUSIONS Administration of IV acetaminophen before third molar surgery provides more effective pain control than postoperative administration and no treatment.
Collapse
Affiliation(s)
- K Kano
- Graduate School of Dentistry, Osaka Dental University Kuzuhahanazono-cho 8-1, Hirakata-shi Osaka 573-1211, Japan
| | | | | |
Collapse
|
14
|
Ramires GAD, de Souza Santos AM, Momesso GAC, Polo TOB, Silva WPP, Barbosa S, Bassi APF, Faverani LP. Combination of etodolac and dexamethasone improves preemptive analgesia in third molar surgery: a randomized study. Clin Oral Investig 2020; 25:2297-2305. [PMID: 32875383 DOI: 10.1007/s00784-020-03552-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This randomized, controlled, triple-blind, crossover clinical trial aimed to investigate the use of dexamethasone (DEX) and etodolac (ETO) as preemptive analgesia before mandibular third molar extraction. METHODS Patients were divided into three groups (n = 20 teeth each) based on the drug administered: DEX 8 mg (DEX); DEX 8 mg plus ETO 300 mg (DEX + ETO), and ETO 300 mg (ETO). Paracetamol (750 mg) tablets were administered as rescue analgesics. Pain was evaluated using the visual analog scale (VAS) at 6, 12, 24, 48, and 72 h and 7 days postoperatively. Edema and trismus were assessed 48 and 72 h postoperatively. All data were subjected to statistical analysis, where a P value < .05 indicated statistical significance. RESULTS VAS scores and the number of rescue analgesics taken were lower in the DEX + ETO group than in the other groups (P < .001 and P = .014, respectively). At 48 h, trismus was similar among all groups; however, the ETO group showed the highest trismus 7 days postoperatively (P < .05). Edema was similar among all groups at all time points (P > .05). CONCLUSION The combined use of the anti-inflammatory drugs, DEX and ETO, resulted in better pain control and the need for fewer rescue analgesics than the use of either drug alone, which indicated their effectiveness in mandibular third molar extractions preoperatively. CLINICAL RELEVANCE This drug combination can lead to less pain, edema, and trismus and reduce the use of rescue analgesics in the postoperative period.
Collapse
Affiliation(s)
- Guilherme André D Ramires
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - Anderson Maikon de Souza Santos
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - Gustavo A C Momesso
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - Tárik Ocon B Polo
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - William P P Silva
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - Stéfany Barbosa
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - Ana Paula F Bassi
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil
| | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo, 16015-050, Brazil.
| |
Collapse
|
15
|
Kp K, R B. Evaluation and comparison of anti-inflammatory properties of ibuprofen using two drug delivery systems after third molar surgery: using chitosan microspheres as a carrier for local drug delivery in to the third molar socket and through the oral route. Br J Oral Maxillofac Surg 2020; 59:191-196. [PMID: 33483157 DOI: 10.1016/j.bjoms.2020.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 08/10/2020] [Indexed: 11/27/2022]
Abstract
We undertook this study to assess the analgesic and anti-inflammatory properties of ibuprofen when administered through two drug delivery systems after mandibular third molar surgery. The study was conducted on 100 patients who required the surgical removal of impacted mandibular third molars under local anaesthesia. The study subjects were divided into two groups of 50 patients each. Patients in the study group were given ibuprofen-incorporated chitosan-based microspheres, which were packed into the third molar sockets after removal of impacted teeth. Patients in the control group were prescribed with ibuprofen 400mg tablets that were to be administered orally after the removal of impacted mandibular third molars. All patients were assessed for pain, swelling, and trismus on the second, fourth, and seventh postoperative days, and wound healing was assessed on the seventh postoperative day. Patients in the study group had significantly less pain and comparatively better mouth opening on the second, fourth, and seventh postoperative days, which showed clinically and statistically significant results of p<0.05, respectively, while the assessment of swelling for the study group did not show statistically significant results on any of the three postoperative days. Among 50 patients in the study group, two had wound gaping, and among 50 patients in the control group, four presented with wound gaping and three patients developed dry socket. Ibuprofen-incorporated chitosan-based microspheres (study group) had comparatively better analgesic and anti-inflammatory properties with drastic reduction of pain, swelling, trismus, and also had a reliable wound healing property when compared with the orally-administered ibuprofen (control group) after mandibular third molar surgery.
Collapse
Affiliation(s)
- Karthik Kp
- PT BD Sharma University, Postgraduate Institute of Dental Sciences, Rohtak, India.
| | | |
Collapse
|
16
|
Kim MG, Kim MY. Effects of kinesiology tape after enucleation of mandibular dentigerous cysts. J Korean Assoc Oral Maxillofac Surg 2020; 46:108-115. [PMID: 32364350 PMCID: PMC7222623 DOI: 10.5125/jkaoms.2020.46.2.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/07/2022] Open
Abstract
Objectives Kinesiology tape (KT) creates a pulling force on the skin, thus improving blood and lymph flow by alleviating hemorrhage and congestion of lymphatic fluid. The authors hypothesized that the use of KT could be beneficial for the management of complications after head and neck surgery and designed this study to evaluate the effects of KT on swelling, pain, and trismus after enucleation of mandibular dentigerous cysts with third molar extraction. Materials and Methods Forty patients who underwent enucleation of a dentigerous cyst with extraction of the mandibular third molar were selected. The patients were randomized into two groups (n=20 each): a KT group, where KT was applied after surgery in addition to basic postoperative care, and a control group, where patients received basic postoperative care without KT application. Swelling, pain, and trismus were evaluated before surgery (T0) and on postoperative days 1 (T1), 2 (T2), and 3 (T3). Cyst volume, gauze weight for assessing bleeding, and operation time were recorded. Results There was a significant difference between the two groups in the change in swelling up to T1 and the change in swelling between T1 and T2. The maximum swelling in the KT group was significantly less than that in the No-KT group and maximum swelling appeared faster in the KT group than in the No-KT group. Both groups showed a mild pain response but there was no significant difference between the two groups. There was no significant difference on interincisal distance change between the two groups. There were no correlations between cyst volume, bleeding, operation time, and maximum swelling. Conclusion KT can effectively manage facial swelling after oral and maxillofacial surgeries such as cyst enucleation and third molar extraction, thus improving postoperative patient satisfaction levels and quality of life.
Collapse
Affiliation(s)
- Min-Gyu Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| | - Moon-Young Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| |
Collapse
|
17
|
Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study. J Oral Maxillofac Surg 2019; 77:1990-1997. [DOI: 10.1016/j.joms.2019.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
|
18
|
Lietz-Kijak D, Kijak E, Krajczy M, Bogacz K, Łuniewski J, Szczegielniak J. The Impact of the Use of Kinesio Taping Method on the Reduction of Swelling in Patients After Orthognathic Surgery: A Pilot Study. Med Sci Monit 2018; 24:3736-3743. [PMID: 29861496 PMCID: PMC6015478 DOI: 10.12659/msm.909915] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Orthognathic surgery (OGS) is associated with extensive surgical intervention within the soft and hard tissues of the facial region of the skull leading to inflammatory reactions. The presence of postoperative swelling indicates the accumulation of exudate or transudate; both these fluids occur in surgery. Massive swelling is a significant problem, because the tension of tissues intensifies pain sensations. The aim of the study was to evaluate the effectiveness of the kinesio taping method (KT) in patients after orthognathic surgery in the area of the facial skull in terms of eliminating postoperative swelling. MATERIAL AND METHODS The study of the impact of kinesiology tape applied after orthognathic surgery to the craniofacial area on the elimination of swelling was performed in sixteen patients who suffered from this complication after bilateral sagittal split osteotomy. RESULTS The swelling was shown to be reduced after KT; within the same study the differences were statistically significant between the left and right sides and for the same side (p<0.05). The application of the lymphatic kinesio taping method led to the reduction of tension in the affected area and restoration of proper lymphatic circulation in the region covered by swelling. This allows for the improvement of the blood and lymph microcirculation and activation of self-healing processes. CONCLUSIONS The analysis of the impact of the practical use of the lymphatic KT on complications after orthognathic surgery revealed that it had a beneficial effect on the reduction of swelling. The use of the KT method seems promising because it is simple to carry out, not traumatic, economical and rarely causes undesirable allergies.
Collapse
Affiliation(s)
- Danuta Lietz-Kijak
- Independent Laboratory of Propaedeutic and Dental Physical Diagnostics, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Edward Kijak
- Scientific Laboratory of Dysfunction of the Masticatory System, Chair and Department of Prosthodontics, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Krajczy
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Katarzyna Bogacz
- Department of Clinical Physiotherapy, Opole University of Technology, Opole, Poland
| | - Jacek Łuniewski
- Department of Clinical Physiotherapy, Opole University of Technology, Opole, Poland
| | - Jan Szczegielniak
- Department of Clinical Physiotherapy, Opole University of Technology, Opole, Poland
| |
Collapse
|
19
|
Sirintawat N, Sawang K, Chaiyasamut T, Wongsirichat N. Pain measurement in oral and maxillofacial surgery. J Dent Anesth Pain Med 2017; 17:253-263. [PMID: 29349347 PMCID: PMC5766084 DOI: 10.17245/jdapm.2017.17.4.253] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/04/2022] Open
Abstract
Regardless of whether it is acute or chronic, the assessment of pain should be simple and practical. Since the intensity of pain is thought to be one of the primary factors that determine its effect on a human's overall function and sense, there are many scales to assess pain. The aim of the current article was to review pain intensity scales that are commonly used in dental and oral and maxillofacial surgery (OMFS). Previous studies demonstrated that multidimensional scales, such as the McGill Pain Questionnaire, Short form of the McGill Pain Questionnaire, and Wisconsin Brief Pain Questionnaire were suitable for assessing chronic pain, while unidimensional scales, like the Visual Analogue Scales (VAS), Verbal descriptor scale, Verbal rating scale, Numerical rating Scale, Faces Pain Scale, Wong-Baker Faces Pain Rating Scale (WBS), and Full Cup Test, were used to evaluate acute pain. The WBS is widely used to assess pain in children and elderly because other scales are often difficult to understand, which could consequently lead to an overestimation of the pain intensity. In dental or OMFS research, the use of the VAS is more common because it is more reliable, valid, sensitive, and appropriate. However, some researchers use NRS to evaluate OMFS pain in adults because this scale is easier to use than VAS and yields relatively similar pain scores. This review only assessed pain scales used for post-operative OMFS or dental pain.
Collapse
Affiliation(s)
- Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kamonpun Sawang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| |
Collapse
|
20
|
Barbalho J, Vasconcellos R, de Morais H, Santos L, Almeida RDA, Rêbelo H, Lucena E, de Araújo S. Effects of co-administered dexamethasone and nimesulide on pain, swelling, and trismus following third molar surgery: a randomized, triple-blind, controlled clinical trial. Int J Oral Maxillofac Surg 2017; 46:236-242. [DOI: 10.1016/j.ijom.2016.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/04/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
|
21
|
Comparative Assessment of the Effect of Ibuprofen and Etodolac on Edema, Trismus, and Pain in Lower Third Molar Surgery: A Randomized Clinical Trial. J Oral Maxillofac Surg 2016; 74:1524-30. [PMID: 27160363 DOI: 10.1016/j.joms.2016.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare the efficacy of ibuprofen (IBU) and etodolac (ETO) for controlling pain, edema, and trismus after extraction of lower third molars. MATERIALS AND METHODS Twenty adolescents and adults with 2 impacted mandibular-third molars (in similar positions) were selected for the study. Patients were randomly assigned either to the IBU group (600 mg of IBU 3 times a day for 3 days) or to the ETO group (300 mg of ETO 3 times a day for 3 days). Drugs were administered immediately after dental extraction. RESULTS During the first 2 days after extraction, swelling was more pronounced in the IBU group than in the ETO group (P = .033). Seven days after surgery, there was no difference in the degree of edema between the groups. At the 2- and 7-day evaluation points, mouth opening was significantly more reduced in the IBU group than in the ETO group (P < .05). After the first 6 hours, the ETO group had more effective pain relief (P < .05), but after this time point, both groups reported similar degrees of relief. Compared with the IBU group, the ETO group had a lower need for administration of additional rescue analgesics. CONCLUSIONS After extraction of impacted lower third molars, we found that swelling, trismus, and pain were more effectively controlled with ETO than with IBU.
Collapse
|
22
|
Olmedo-Gaya MV, Manzano-Moreno FJ, Galvez-Mateos R, González-Rodriguez MP, Talero-Sevilla C, Vallecillo-Capilla M. Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial. Clin Oral Investig 2015; 20:1819-26. [PMID: 26578119 DOI: 10.1007/s00784-015-1657-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/10/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. MATERIALS AND METHODS The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. RESULTS No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042). CONCLUSIONS The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. CLINICAL RELEVANCE These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.
Collapse
Affiliation(s)
- Maria Victoria Olmedo-Gaya
- Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Francisco J Manzano-Moreno
- Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus Universitario de Cartuja, 18071, Granada, Spain. .,Biomedical Research Group (BIO277), Junta de Andalucía, Granada, Spain.
| | - Rafael Galvez-Mateos
- Department of Anesthesia, Virgen de las Nieves University Hospital, Granada, Spain
| | - Maria Paloma González-Rodriguez
- Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Cristina Talero-Sevilla
- Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Manuel Vallecillo-Capilla
- Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus Universitario de Cartuja, 18071, Granada, Spain
| |
Collapse
|
23
|
Costa FWG, Esses DFS, de Barros Silva PG, Carvalho FSR, Sá CDL, Albuquerque AFM, Bezerra TP, Ribeiro TR, Sá Roriz Fonteles C, Soares ECS. Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials. Anesth Prog 2015; 62:57-63. [PMID: 26061574 DOI: 10.2344/0003-3006-62.2.57] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.
Collapse
Affiliation(s)
| | | | | | | | - Carlos Diego Lopes Sá
- Postgraduate Student, Division of Oral Surgery, Post-program in Dentistry, Federal University of Ceará, Fortaleza-CE, Brazil
| | | | - Tácio Pinheiro Bezerra
- Professor, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil
| | | | | | | |
Collapse
|
24
|
Tozzi U, Santagata M, Sellitto A, Tartaro GP. Influence of Kinesiologic Tape on Post-operative Swelling After Orthognathic Surgery. J Maxillofac Oral Surg 2015; 15:52-8. [PMID: 26929553 DOI: 10.1007/s12663-015-0787-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/14/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Orthognathic surgery involves making several osteotomies that lead to varying degrees of post-operative swelling. The use of KT may be beneficial for postoperative treatment after head and neck surgery, accelerating drainage of tissue reaction or haemorrhages. The goal of this study was to find out if the application of KT prevents or improves swelling, pain and trismus after orthognathic surgery, improving patients' postoperative quality of life. MATERIALS AND METHODS In this double-blinded, randomized, control trial, 24 patients in whom bimaxillary orthognathic surgery was indicated, were included. Before surgery each patient alternatively was randomly included in the study group (treated with K-Taping(®) and corticosteroid) or in the control group (treated with corticosteroid). In the present study a MakerBot(®) Digitizer 3D™ was used to assess accurate volume measurements. All swelling measurements were expressed as total 3-D area of the landmarks (cm(2) ) in T0 pre-operative, T1 fourth day after surgery. RESULTS The differences T0-T1 are highly significant (p < 0.01) between group 1 or study group (treated with K-taping(®)) and group 2 (control group). DISCUSSION The use of KT appears promising, because it is simple to carry out, less traumatic, economical, can be performed everywhere in the world, free from side effects on the body. Even when swelling persists, KT gives patients the impression of a minor swelling detracting them from their pain and morbidity. Further studies have to be performed to find out if KT can reduce or replace the need for additional medications such as the use of steroids.
Collapse
Affiliation(s)
- U Tozzi
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical and Dental Specialties, AOU - SUN (Second University of Naples), Naples, Italy ; Via P. Riverso, 102, 81031 Aversa, CE Italy
| | - M Santagata
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical and Dental Specialties, AOU - SUN (Second University of Naples), Naples, Italy
| | - A Sellitto
- Department of Industrial and Information Engineering, SUN (Second University of Naples), Aversa, Italy
| | - G P Tartaro
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical and Dental Specialties, AOU - SUN (Second University of Naples), Naples, Italy
| |
Collapse
|
25
|
Ristow O, Pautke C, Kehl V, Koerdt S, Hahnefeld L, Hohlweg-Majert B. Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis. Physiother Theory Pract 2014; 30:390-8. [PMID: 24575949 DOI: 10.3109/09593985.2014.891068] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients' quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients' satisfaction after OMF surgery. MATERIALS AND METHODS Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n = 30, mandibular fractures n = 26, wisdom tooth removal n = 40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5 d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients' objective feeling and satisfaction was queried. RESULTS Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2 d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5 cm ± 4.3; T3: 62.5 cm ± 4.2; T4: 61.6 cm ± 4.2) than in the no-KT group (T2: 67.6 cm ± 5.0; T3: 67.0 cm ± 5.0; T4: 64.8 cm ± 4.8) at T2 (p < 0.001), T3 (p < 0.001), and T4 (p = 0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5 ± 2.0 (p = 0.006); T2: 1.7 ± 2.0 (p < 0.001); T3: 1.5 ± 2.3 (p = 0.004); T4: 0.6 ± 1.1 (p = 0.001) compared to the no-KT group (T1: 3.8 ± 2.5; T2: 3.5 ± 2.7; T3: 2.9 ± 2.2; T4: 1.6 ± 1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: -0.08 cm ± 0.49 (p = 0.025); T2-BL: 0.07 cm ± 0.59 (p = 0.012); T3-BL: 0.20 ± 0.63 (p = 0.013); T4-BL: 0.42 ± 0.59 (p = 0.003)) compared to the no-KT group (T1-BL: -0.47 cm ± 0.86; T2-BL: -0.39 cm ± 0.84; T3-BL: -0.24 ± 0.89; T4-BL: -0.13 ± 1.02). CONCLUSION KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients' quality of life.
Collapse
Affiliation(s)
- Oliver Ristow
- Medizin und Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery , Munich , Germany
| | | | | | | | | | | |
Collapse
|
26
|
Aravena P, Benso B, Bertín A, Aravena-Torres R. Efectividad de la profilaxis analgésica con clonixinato de lisina en exodoncias: ensayo clínico aleatorio. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2013.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
27
|
Eshghpour M, Mortazavi H, Mohammadzadeh Rezaei N, Nejat A. Effectiveness of green tea mouthwash in postoperative pain control following surgical removal of impacted third molars: double blind randomized clinical trial. ACTA ACUST UNITED AC 2013; 21:59. [PMID: 23866761 PMCID: PMC3720195 DOI: 10.1186/2008-2231-21-59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 07/14/2013] [Indexed: 02/03/2023]
Abstract
Background Pain following surgical removal of impacted molars has remained an important concern among practitioners. Various protocols have been proposed to reduce postoperative pain. However, each one has special side effects and limitations. As green tea possesses anti-inflammatory and antibacterial properties, the aim of the current study was to evaluate the effectiveness of green tea mouthwash in controlling postoperative pain. Materials and methods In a study with split-mouth and double blind design, 44 patients in need of bilateral removal of impacted third molars underwent randomized surgical extraction; following one surgery patients rinsed with a green tea mouthwash from the first to seventh postoperative day and after other extraction rinsed with placebo mouthwash in the same duration. Both patients and surgeon were blinded to the type of mouthwash. The predictor variable was type of mouthwash and primary outcome variable was postoperative pain measured by visual analogue scale (VAS) during first week after surgery. In addition, number of analgesics patients used after surgery recorded. To measure the effect of green tea mouthwash, repeated measures test with confidence interval of 95% was performed. Results Total of 43 patients with mean age of 24 years underwent total of 86 surgeries. VAS value had no statistically difference prior rinsing among groups (P-value > 0.05). However, the mean value of VAS following rinsing with green tea was statistically lower than placebo in postoperative days of 3–7 (P-value < 0.05). In addition, while rinsing with green tea, patients took significantly lower number of analgesics after surgery (P-value < 0.05). No side effects reported. Conclusion Green tea mouthwash could be an appropriate and safe choice to control postoperative pain after third molar surgery.
Collapse
|
28
|
Influence of kinesiologic tape on postoperative swelling, pain and trismus after zygomatico-orbital fractures. J Craniomaxillofac Surg 2013; 42:469-76. [PMID: 23830769 DOI: 10.1016/j.jcms.2013.05.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment of zygomatico-orbital (ZO) fractures is a common procedure in maxillofacial surgery. Often accompanied by pain, trismus and swelling, postoperative morbidity is a major disadvantage, affecting patients' quality of life. The appliance of kinesiologic tape (KT) improves the blood and lymph flow, removing congestions of lymphatic fluid and haemorrhages. The aim of this study was to find out if the application of kinesiologic tape prevents or improves swelling, pain and trismus after zygomatico-orbital fracture surgery, improving patients' postoperative quality of life. A total of 30 patients were assigned for treatment of zygomatico-orbital fractures and were randomly divided into treatment either with or without kinesiologic tape. Tape was applied directly after surgery and maintained for at least 5 days postoperatively. Facial swelling was quantified using a five-line measurement at six specific time points. Pain and degree of mouth opening was measured. Patient's subjective feeling and satisfaction was queried. The results of this study show that application of kinesiologic tape after zygomatico-orbital surgery significantly reduced the incidence of swelling with an earlier swelling maximum, and decreased the maximum turgidity for more than 60% during the first 2 days after surgery. Although, kinesiologic tape has no significant influence on pain control and trismus, mouth opening increased earlier after operation in the kinesiologic tape group compared to the no-kinesiologic tape group. Furthermore, patients with kinesiologic tape felt significantly lower morbidity than those without kinesiologic tape. Therefore kinesiologic tape is a promising, simple, less traumatic, economical approach, which is free from adverse reaction and improves patients' quality of life.
Collapse
|
29
|
Ristow O, Hohlweg-Majert B, Kehl V, Koerdt S, Hahnefeld L, Pautke C. Does elastic therapeutic tape reduce postoperative swelling, pain, and trismus after open reduction and internal fixation of mandibular fractures? J Oral Maxillofac Surg 2013; 71:1387-96. [PMID: 23676774 DOI: 10.1016/j.joms.2013.03.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/12/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the present study was to investigate whether the application of elastic therapeutic tape (Kinesio Tape [KT]) prevents or decreases swelling, pain, and trismus after open reduction and internal fixation of mandibular fracture, thus improving patients' postoperative morbidity. MATERIALS AND METHODS To address the research purpose, the investigators designed and implemented an open-label, monocentric, parallel-group, randomized clinical trial. Patients were prospectively assigned for treatment of unilateral mandibular fractures and randomly allocated to receive treatment with or without KT application. KT was applied directly after surgery and maintained for 5 days postoperatively. Facial swelling was quantified using a 5-line measurement at 6 specific time points. Pain score was assessed using a 10-level visual analog scale; mouth opening was measured. In addition, all patients were asked to evaluate overall satisfaction and swelling (2 groups) and the effect of the tape on movement and comfort (KT group only). RESULTS The study included 26 patients (11 female and 15 male; mean age, 43 yr; standard deviation, 18.5 yr). Application of KT after surgery for mandibular fracture had a statistically significant influence on tissue reaction and swelling, decreasing the incidence of swelling and turgidity by more than 60% during the first 2 days after surgery. Although KT had no significant influence on pain control, patients in the KT group perceived significantly lower morbidity. CONCLUSION The present results showed that KT after open reduction and internal fixation of mandibular fracture is a promising, simple, less traumatic, and economical approach for managing postoperative swelling that is free from systemic adverse reactions, thus improving patients' quality of life.
Collapse
Affiliation(s)
- Oliver Ristow
- Medicine and Aesthetics, Private Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
| | | | | | | | | | | |
Collapse
|