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Pessano S, Gloeck NR, Tancredi L, Ringsten M, Hohlfeld A, Ebrahim S, Albertella M, Kredo T, Bruschettini M. Ibuprofen for acute postoperative pain in children. Cochrane Database Syst Rev 2024; 1:CD015432. [PMID: 38180091 PMCID: PMC10767793 DOI: 10.1002/14651858.cd015432.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Children often require pain management following surgery to avoid suffering. Effective pain management has consequences for healing time and quality of life. Ibuprofen, a frequently used non-steroidal anti-inflammatory drug (NSAID) administered to children, is used to treat pain and inflammation in the postoperative period. OBJECTIVES 1) To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. 2) To compare ibuprofen administered at different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled). SEARCH METHODS We used standard Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, CINAHL and trials registries in August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 17 years and younger, treated for acute postoperative or postprocedural pain, that compared ibuprofen to placebo or any active comparator. We included RCTs that compared different administration routes, doses of ibuprofen and schedules. DATA COLLECTION AND ANALYSIS We adhered to standard Cochrane methods for data collection and analysis. Our primary outcomes were pain relief reported by the child, pain intensity reported by the child, adverse events, and serious adverse events. We present results using risk ratios (RR) and standardised mean differences (SMD), with the associated confidence intervals (CI). We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 43 RCTs that enroled 4265 children (3935 children included in this review). We rated the overall risk of bias at the study level as high or unclear for 37 studies that had one or several unclear or high risk of bias judgements across the domains. We judged six studies as having a low risk of bias across all domains. Ibuprofen versus placebo (35 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen probably reduces child-reported pain intensity less than two hours postintervention compared to placebo (SMD -1.12, 95% CI -1.39 to -0.86; 3 studies, 259 children; moderate-certainty evidence). Ibuprofen may reduce child-reported pain intensity, two hours to less than 24 hours postintervention (SMD -1.01, 95% CI -1.24 to -0.78; 5 studies, 345 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events compared to placebo (RR 0.79, 95% CI 0.51 to 1.23; 5 studies, 384 children; low-certainty evidence). Ibuprofen versus paracetamol (21 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen likely reduces child-reported pain intensity less than two hours postintervention compared to paracetamol (SMD -0.42, 95% CI -0.82 to -0.02; 2 studies, 100 children; moderate-certainty evidence). Ibuprofen may slightly reduce child-reported pain intensity two hours to 24 hours postintervention (SMD -0.21, 95% CI -0.40 to -0.02; 6 studies, 422 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events (0 events in each group; 1 study, 44 children; low-certainty evidence). Ibuprofen versus morphine (1 RCT) No studies reported pain relief or pain intensity reported by the child or a third party, or serious adverse events. Ibuprofen likely results in a reduction in adverse events compared to morphine (RR 0.58, 95% CI 0.40 to 0.83; risk difference (RD) -0.25, 95% CI -0.40 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 4; 1 study, 154 children; moderate-certainty evidence). Ibuprofen versus ketorolac (1 RCT) No studies reported pain relief or pain intensity reported by the child, or serious adverse events. Ibuprofen may result in a reduction in adverse events compared to ketorolac (RR 0.51, 95% CI 0.27 to 0.96; RD -0.29, 95% CI -0.53 to -0.04; NNTB 4; 1 study, 59 children; low-certainty evidence). AUTHORS' CONCLUSIONS Despite identifying 43 RCTs, we remain uncertain about the effect of ibuprofen compared to placebo or active comparators for some critical outcomes and in the comparisons between different doses, schedules and routes for ibuprofen administration. This is largely due to poor reporting on important outcomes such as serious adverse events, and poor study conduct or reporting that reduced our confidence in the results, along with small underpowered studies. Compared to placebo, ibuprofen likely results in pain reduction less than two hours postintervention, however, the efficacy might be lower at two hours to 24 hours. Compared to paracetamol, ibuprofen likely results in pain reduction up to 24 hours postintervention. We could not explore if there was a different effect in different kinds of surgeries or procedures. Ibuprofen likely results in a reduction in adverse events compared to morphine, and in little to no difference in bleeding when compared to paracetamol. We remain mostly uncertain about the safety of ibuprofen compared to other drugs.
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Affiliation(s)
- Sara Pessano
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Natasha R Gloeck
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Luca Tancredi
- Geriatrie, Hessing Stiftung, Augsburg, Germany
- Medical School, Regiomed, Coburg, Germany
| | - Martin Ringsten
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ameer Hohlfeld
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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2
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Tamimi Z, Abusamak M, Al-Waeli H, Al-Tamimi M, Al Habashneh R, Ghanim M, Al-Nusair M, Gao Q, Nicolau B, Tamimi F. NSAID chronotherapy after impacted third molar extraction: a randomized controlled trial. Oral Maxillofac Surg 2022; 26:663-672. [PMID: 35064366 DOI: 10.1007/s10006-021-01029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Postoperative pain management impacts patients' quality of life and morbidity. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely used for this following a 3-doses-per-day regime. However, pain and inflammation follow a circadian rhythm, and animal models assessing the scheduling of NSAID administration (e.g., chronotherapy) have shown that while their use during the active phase of the day enhances postoperative recovery, their administration during the resting phase could have detrimental effects. This observation has led us to hypothesize that night administration of NSAID might be unnecessary in post-surgical scenarios. Therefore, a randomized clinical trial was conducted to test this hypothesis in surgical third molar extractions. MATERIALS AND METHODS Seventy (18-35 years) healthy participants requiring surgical removal of impacted lower third molars were recruited and randomized into a double-blind placebo-controlled study. For three days postoperatively, the treatment group (n = 33) received ibuprofen (400 mg) at 8 AM, 1 PM, and a placebo at 8 PM, while the control group (n = 37) received ibuprofen (400 mg) at 8 AM, 1 PM, and 8 PM. Pain severity was assessed by visual analog scale (VAS) and healing indicators including facial swelling, mouth opening, and C-reactive protein blood levels were also measured. RESULTS Pain VAS measures showed a circadian variation peaking at night. Also, no significant differences were observed between the two groups of the study in terms of postoperative pain scores (estimate: 0.50, 95% CI = [- 0.38, 1.39]) or any other healing indicator. CONCLUSIONS Postoperative pain follows a circadian rhythm. Moreover, night administration of ibuprofen might not provide any significant benefits in terms of pain management and control of inflammation, and two doses during the day only could be sufficient for pain management after surgical interventions. KNOWLEDGE TRANSFER STATEMENT Even though this study cannot rule out the possibility that a reduced regime is different than a standard regime, nocturnal doses of ibuprofen seem to have no clinical significance in the short term, and the results of this study provide evidence in favor of reducing ibuprofen administration from three doses to two doses only after third molar surgery.
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Affiliation(s)
- Zaid Tamimi
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | | | - Haider Al-Waeli
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | | | - Rola Al Habashneh
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Ghanim
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Al-Nusair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Qiman Gao
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Belinda Nicolau
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Faleh Tamimi
- College of Dental Medicine, Qatar University, Doha, Qatar
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3
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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.
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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
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Selvido DI, Bhattarai BP, Niyomtham N, Riddhabhaya A, Vongsawan K, Pairuchvej V, Wongsirichat N. Review of dexamethasone administration for management of complications in postoperative third molar surgery. J Korean Assoc Oral Maxillofac Surg 2021; 47:341-350. [PMID: 34713808 PMCID: PMC8564082 DOI: 10.5125/jkaoms.2021.47.5.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.
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Affiliation(s)
- Diane Isabel Selvido
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Apiwat Riddhabhaya
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Kadkao Vongsawan
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | | | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
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5
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Martins-de-Barros AV, Barros AM, Siqueira AK, Lucena EE, Sette de Souza PH, Araújo FA. Is Dexamethasone superior to Ketorolac in reducing pain, swelling and trismus following mandibular third molar removal? A split mouth triple-blind randomized clinical trial. Med Oral Patol Oral Cir Bucal 2021; 26:e141-e150. [PMID: 33247572 PMCID: PMC7980286 DOI: 10.4317/medoral.24088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background The preemptive use of anti-inflammatory drugs, such as corticosteroids and NSAIDs, has the potential to reduce pain, swelling and trismus following oral surgery. The aim of this study was to compare the efficacy of dexamethasone and ketorolac tromethamine in reducing pain, swelling and trismus after mandibular third molar removal.
Material and Methods The researches implemented a triple-blind, randomized clinical trial. The study was conducted with ASA I individuals aging between 18 and 35 years, which were randomized and submitted to two interventions, one with 8mg dexamethasone and the other with 20mg ketorolac tromethamine given 1h before the procedure. The primary predictor variable was the use of dexamethasone or ketorolac. The primary outcome variable was the postoperative pain level, measured with a Visual Analogue Scale. The secondary outcome variables were the amount of rescue analgesic consumed, swelling and trismus. Repeated-measures ANOVA and t-test for paired samples were used to compare the means. Significance was set at p < 0.05.
Results Fifty individuals were randomized and allocated to intervention, and the sample was composed of 40 subjects who completed the study (27 female and 13 male). Dexamethasone, when compared to ketorolac tromethamine, showed a significantly higher reduction in pain level at 8h, 16h, 24h, 32h, 40h and 72h, in swelling and trismus at 24h, 48h, 72h and 7 days and in total number of rescue analgesics taken up to 72h postoperative (p < 0.05).
Conclusions The clinical performance of dexamethasone in controlling pain, swelling and trismus after mandibular third molar removal was superior to ketorolac tromethamine’s. Key words:Third Molar, anti-inflammatory agents, dexamethasone, ketorolac.
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Affiliation(s)
- A-V Martins-de-Barros
- Hospital Universitário Oswaldo Cruz University of Pernambuco, Campus Santo Amaro Rua Arnóbio Marquês, 310 Santo Amaro, Recife, Pernambuco, Brazil
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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.
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Affiliation(s)
- L-D Silva
- José Bonifácio street number 1193 16015-050, Araçatuba, São Paulo, Brazil
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7
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La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Cristalli MP. Effects of ibuprofen administration timing on oral surgery pain: A randomized clinical trial. Oral Dis 2021; 28:796-804. [PMID: 33486855 DOI: 10.1111/odi.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the analgesic effect of ibuprofen 400 mg given 30 min before or immediately after third molars surgery under local anaesthesia. MATERIALS AND METHODS The single-centre, randomized, split-mouth, triple-blind, clinical trial involved 38 outpatients, for a total of 76 bilateral symmetrical fully bone impacted mandibular third molars. Each patient was undergone to separate surgical sessions for the right and left side, and ibuprofen was randomly administered 30 min before or immediately after the intervention. Study participants recorded pain intensity using Numerical Rating Scale-11, the timing of rescue therapy intake and overall tablets consumption over 3 days. RESULTS The overall pain intensity score was lower in the group receiving ibuprofen immediately after (3.13 ± 2.46) than before (3.58 ± 2.40) surgery, with statistically significant differences only on the second and third days. The mean time to the first using rescue therapy was longer in the postoperative (598.33 ± 422.62 min) than in the preoperative (406.25 ± 149.79 min) analgesic treatment group (p = .123). The number of supplemented ibuprofen tablets did not differ (p = .530) between both groups. CONCLUSIONS Within the limits of the present study, ibuprofen administration immediately after surgery seemed to be more effective than preoperative administration.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Susanna Annibali
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, Sapienza University of Rome, Rome, Italy
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8
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Sugragan C, Sirintawat N, Kiattavornchareon S, Khoo LK, Kc K, Wongsirichat N. Do corticosteroids reduce postoperative pain following third molar intervention? J Dent Anesth Pain Med 2020; 20:281-291. [PMID: 33195806 PMCID: PMC7644360 DOI: 10.17245/jdapm.2020.20.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. Methods The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. Results Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. Conclusions Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.
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Affiliation(s)
- Chollathit Sugragan
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Lee Kian Khoo
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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9
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Naghipour A, Esmaeelinejad M, Dehnad SV, Shahi A, Jarrahi A. Comparison of lidocaine with articaine buccal injection in reducing complications following impacted mandibular third molar surgery: a split-mouth randomized clinical trial. J Dent Anesth Pain Med 2020; 20:213-221. [PMID: 32934987 PMCID: PMC7470994 DOI: 10.17245/jdapm.2020.20.4.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Complications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery. Methods The study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed. Results The findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant. Conclusion Choosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.
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Affiliation(s)
- Amin Naghipour
- Student Research Committee, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Esmaeelinejad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyed Vahid Dehnad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Anahita Shahi
- Department of Periodontology, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Jarrahi
- Student Research Committee, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
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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.
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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.
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11
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Isola G, Matarese G, Alibrandi A, Dalessandri D, Migliorati M, Pedullà E, Rapisarda E. Comparison of Effectiveness of Etoricoxib and Diclofenac on Pain and Perioperative Sequelae After Surgical Avulsion of Mandibular Third Molars: A Randomized, Controlled, Clinical Trial. Clin J Pain 2019; 35:908-915. [PMID: 31368908 DOI: 10.1097/ajp.0000000000000748] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this analysis was to compare the efficacy of etoricoxib and diclofenac in the management of perioperative sequelae following impacted mandibular third molar surgery. MATERIALS AND METHODS Ninety-seven patients who needed surgical avulsion of an impacted mandibular third molar were chosen for the study. All patients were randomly allocated to receive one of the following treatments, twice a day for 5 days after surgery: placebo (n=33), diclofenac (n=32), or etoricoxib (n=32). The primary outcome evaluated was postoperative pain, recorded by each patient and evaluated using the Visual Analogue Scale score. The secondary outcomes chosen were, compared with preoperative ones, changes in postoperative swelling and maximum mouth opening. RESULTS Compared with placebo, treatment with etoricoxib and diclofenac demonstrated an enhancement in the primary outcome. Furthermore, when compared with the other groups, patients who had undergone etoricoxib presented a significant median reduction in postoperative pain at 2 hours (P<0.001), 12 hours (P=0.025), and at 48 hours (P=0.018) after surgery. Moreover, the linear regression analysis showed that diclofenac and etoricoxib determined a significant influence on Visual Analogue Scale at 2, 6, 12, 24, 48 hours and at 10 days after surgery. There were no differences in swelling and maximum mouth opening values between groups. DISCUSSION This study demonstrated that both treatments were effective. However, treatment with etoricoxib showed a greater reduction in the incidence and severity of postoperative pain following third molar surgery compared with diclofenac and placebo.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania
| | - Giovanni Matarese
- Department of Biomedical and Odontostomatological Sciences and Morphological and Functional Images, School of Dentistry
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina
| | - Domenico Dalessandri
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia
| | - Marco Migliorati
- Department of Odontostomatology, School of Dentistry, University of Genova, Genova, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania
| | - Ernesto Rapisarda
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania
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12
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Isola G, Matarese M, Ramaglia L, Cicciù M, Matarese G. Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: a randomized, controlled clinical trial. Int J Oral Maxillofac Surg 2019; 48:1348-1354. [PMID: 30853212 DOI: 10.1016/j.ijom.2019.02.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/12/2018] [Accepted: 02/12/2019] [Indexed: 02/07/2023]
Abstract
The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5days after surgery: placebo (n=32), ibuprofen (n=33), or celecoxib (n=33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6h (P<0.001), 12h (P=0.011), and 24h (P=0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.
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Affiliation(s)
- G Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy; Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy.
| | - M Matarese
- Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy
| | - L Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - M Cicciù
- Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy
| | - G Matarese
- Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy
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Wongpang D, Makeudom A, Sastraruji T, Khongkhunthian S, Krisanaprakornkit S, Supanchart C. Anesthetic efficacies of intrapapillary injection in comparison to inferior alveolar nerve block for mandibular premolar extraction: a randomized clinical trial. Clin Oral Investig 2019; 24:619-629. [PMID: 31115690 DOI: 10.1007/s00784-019-02954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Intrapapillary injection (IPI) has been suggested to improve pulpal anesthesia of mandibular teeth and to avoid complications from inferior alveolar nerve block (IANB). This study aimed to determine and compare clinical efficacies and prostaglandin E2 (PGE2) levels between IPI and IANB. MATERIALS AND METHODS IANB was randomly selected for mandibular premolar anesthesia on one side of 40 patients, whereas IPI was locally administered to the contralateral premolar. Pulpal anesthesia, pain during injection and extraction, patients' satisfaction, and complications were assessed from 30 patients. Gingival crevicular fluid from ten patients was collected for PGE2 quantification by ELISA. RESULTS Of 30 patients, 18 preferred IPI after injection due to significantly faster mean onset of pulpal anesthesia (p < 0.001) and lower mean score of injection pain (p = 0.017) than IANB, but 21 preferred IANB instead after extraction due to less postoperative pain, consistent with the significantly lower median PGE2 level on the IANB side than that on the IPI at 30 min (p = 0.047). However, there was no difference in the mean satisfaction score between the two techniques. Ulcerated epithelium and sloughing tissues were found at the IPI site in some patients with complete healing within 2 weeks. CONCLUSIONS The anesthetic efficacies of IPI for mandibular premolar extraction are comparable to those of IANB. However, postoperative pain and local complications at the IPI site should be considered. CLINICAL RELEVANCE IPI may be used for dental procedures that require only a short anesthetic duration to avoid failure of pulpal anesthesia, complications, and discomfort from IANB.
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Affiliation(s)
- Duangkamon Wongpang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Anupong Makeudom
- Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Thanapat Sastraruji
- Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Sakornrat Khongkhunthian
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Suttichai Krisanaprakornkit
- Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.,Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chayarop Supanchart
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand. .,Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
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14
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Raldi FV, Nascimento RD, Sato FRL, Santos LM, Amorim JBO, de Moraes MB. Evaluation of the impact of preoperative use of dexamethasone and cyclobenzaprine in surgical extraction of lower third molars on trismus by electromyographic analysis. Oral Maxillofac Surg 2019; 23:395-405. [PMID: 31119419 DOI: 10.1007/s10006-019-00776-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 05/02/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to evaluate the influence of cyclobenzaprine and dexamethasone on the electrical activity of the masticatory muscles in patients who had undergone lower third molar surgery. METHODS Thirty bilateral impacted lower third molars with indication of extraction were randomised into three groups: the control group, the dexamethasone, and the cyclobenzaprine group. To obtain muscular electrical activity and mouth opening, an electromyographic device was used at mandibular rest and maximum voluntary contraction and compared pre- and post-operatively. RESULTS During muscle contraction, no significant difference was observed in the electromyographic records on the non-operated side. On the operated side, there was a reduction in electrical activity for both drugs pre-operatively and immediately post-operatively compared to the control group. All pharmacological agents promoted a higher mouth opening compared to control group. CONCLUSION The results suggest that dexamethasone and cyclobenzaprine may be useful as an adjuvant in the prevention of motor dysfunctions in third molar surgery.
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Affiliation(s)
- Fernando Vagner Raldi
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - Rodrigo Dias Nascimento
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - Fábio Ricardo Loureiro Sato
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil. .,Department of Oral and Maxillofacial Surgery, College of Dentistry, State University of São Paulo - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, SP, 12245-000, Brazil.
| | - Lucio Murillo Santos
- Department of Bioscience and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - José Benedito Oliveira Amorim
- Department of Bioscience and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - Michelle Bianchi de Moraes
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
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Isola G, Alibrandi A, Pedullà E, Grassia V, Ferlito S, Perillo L, Rapisarda E. Analysis of the Effectiveness of Lornoxicam and Flurbiprofen on Management of Pain and Sequelae Following Third Molar Surgery: A Randomized, Controlled, Clinical Trial. J Clin Med 2019; 8:jcm8030325. [PMID: 30866586 PMCID: PMC6463050 DOI: 10.3390/jcm8030325] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to analyze the effectiveness of Lornoxicam and Flurbiprofen in reducing perioperative sequelae after impacted mandibular third molar surgery. Ninety-one patients who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 29), Flurbiprofen (n = 31), or Lornoxicam (n = 31). The primary outcome was postoperative pain, evaluated using the visual analogue scale (VAS) score at 30 min, 2, 6, 12, 24, 48 h, 7 and 10 days following surgery. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with Flurbiprofen and Lornoxicam was characterised by an improvement in the primary outcome. Moreover, the treatment with Lornoxicam presented significantly lower median pain scores at 2 h (p < 0.001) and at 6 h (p = 0.016) compared to Flurbiprofen and at 2 h (p < 0.001), 6 h (p = 0.01), and at 24 h (p = 0.018) after surgery compared with placebo. Swelling and maximum mouth opening values were not significantly different between the groups at each follow-up session. This trial demonstrated that treatment with Lornoxicam showed a decrease in the incidence and severity of pain in the first postoperative phase following third molar surgery compared to Flurbiprofen and placebo.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy.
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods,University of Messina, 98122 Messina, Italy.
| | - Eugenio Pedullà
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy.
| | - Vincenzo Grassia
- Department of Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Sebastiano Ferlito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy.
| | - Letizia Perillo
- Department of Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Ernesto Rapisarda
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy.
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16
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Almeida RDA, Lemos C, de Moraes S, Pellizzer E, Vasconcelos B. Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2019; 48:118-131. [DOI: 10.1016/j.ijom.2018.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
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17
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Giorgetti APO, Matos RD, Casarin RCV, Pimentel SP, Cirano FR, Ribeiro FV. Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft. Braz Dent J 2018; 29:23-29. [DOI: 10.1590/0103-6440201801452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student’s t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.
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18
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Al-Dajani M. Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery? J Oral Maxillofac Surg 2017; 75:1616-1626. [DOI: 10.1016/j.joms.2017.03.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 03/04/2017] [Accepted: 03/19/2017] [Indexed: 01/01/2023]
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19
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Franco-Molina MA, Mendoza-Gamboa E, Coronado-Cerda EE, Zarate-Triviño D, Arizpe-Coronado JE, Zapata-Benavides P, Ramos Zayas Y, Tamez-Guerra R, Rodríguez-Padilla C. Clinical trial evaluating the effectiveness of biocompound IMMUNEPOTENT CRP in the third-molar extraction. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2016.1249408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Moises A. Franco-Molina
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Edgar Mendoza-Gamboa
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Erika E. Coronado-Cerda
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Diana Zarate-Triviño
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Juan E. Arizpe-Coronado
- Department of Oral and Maxillofacial Surgery, Faculty of Odontology, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Pablo Zapata-Benavides
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Yareellys Ramos Zayas
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Reyes Tamez-Guerra
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - Cristina Rodríguez-Padilla
- Department of Microbiology and Immunology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
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Paiva-Oliveira JG, Bastos PRHO, Cury Pontes ERJ, da Silva JCL, Delgado JAB, Oshiro-Filho NT. Comparison of the anti-inflammatory effect of dexamethasone and ketorolac in the extractions of third molars. Oral Maxillofac Surg 2016; 20:123-133. [PMID: 26572899 DOI: 10.1007/s10006-015-0533-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 11/01/2015] [Indexed: 06/05/2023]
Abstract
This double-blind, split-mouth, and randomized study was aimed to compare the efficacy of dexamethasone and ketorolac tromethamine, through the evaluation of pain, edema, and limitation of mouth opening. Thirty-four individuals aged 18-26 years, having bilateral mandibular third molars, in a similar position, were selected. Two different surgical procedures were performed on the same individual by the single surgeon. For an extraction, the individual received 1 capsule of 10 mg ketorolac tromethamine 1 h before surgery and every 8 h for 2 days. For the extraction of the contralateral side, the individual received 1 capsule of 8 mg dexamethasone 1 h before surgery and 1 placebo capsule every 8 h for 2 days. Sodium metamizol, 500 mg, was given as rescue medication in postoperative. Pain was assessed by the Visual Box Scale-11 points (BS-11) at 24 h postoperative. Edema (metric measurement) and the maximum mouth opening (interincisal) were recorded in the pre-operative, 24 h, 48 h, 72 h and 7 days postoperatively. The results showed that both therapeutic treatments used were effective in the postoperative, and there were no statistically significant differences between the groups for the pain and edema variables. However, for the limitation of mouth opening, 24 h and 7 days postoperatively, the dexamethasone group had a lower limitation of mouth opening, behaving better than the ketorolac for this variable in these periods. Due also to the higher margin of safety, the use of dexamethasone as a single dose becomes a more suitable alternative for use in routine surgical extractions of third molars.
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Affiliation(s)
- Janayna Gomes Paiva-Oliveira
- Program in Health Science and Development of the Midwest Region of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
| | - Paulo Roberto Haidamus Oliveira Bastos
- Program in Health Science and Development of the Midwest Region of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Elenir R J Cury Pontes
- Program in Health Science and Development of the Midwest Region of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Júlio César Leite da Silva
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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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.
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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
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