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Gounari MM, Tsaousi G, Zouloumis L, Kouvelas D, Pourzitaki C. Efficacy and safety of parenteral and local application of tramadol in mandibular third molar extraction: a qualitative systematic review of current evidence. Oral Maxillofac Surg 2024; 28:499-513. [PMID: 37640978 DOI: 10.1007/s10006-023-01179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To assess the efficacy and safety of perioperative parenteral administration or submucosal infiltration of tramadol for perioperative pain control on the basis of pain intensity or analgesics consumption and perioperative outcomes in mandibular third molar surgery. MATERIAL-METHODS An electronic database search was conducted up to 10 November 2022 to retrieve all randomized controlled trials (RCTs), assessing the analgesic efficacy of parenteral use of tramadol implemented as an adjunct to local anesthesia or intraoperative sedation/general anesthesia, in surgical extraction of mandibular third molars. Modified Jadad scale and Cochrane bias tool were used for the qualitative appraisal. RESULTS Nineteen RCTs were selected for qualitative analysis. Nine studies involved intravenous, and 5 intramuscular administration of tramadol, while 5 evaluated submucosal infiltration with tramadol. Intravenous or intramuscular tramadol provided a weaker analgesic effect compared with non-steroidal anti-inflammatory drugs (NSAIDs), while intravenous tramadol induced an enhanced analgesic effect than oral tramadol. Parenteral administration of tramadol improved the quality of postoperative analgesia versus placebo. No notable adverse effects were recorded. CONCLUSIONS Parenteral or submucosal infiltration of tramadol constitutes an effective and safe alternative analgesic approach in surgical extraction of mandibular third molars, yet the nociceptive effect of this analgesic modality could not supersede that of NSAIDs. TRIAL REGISTRATION PROSPERO No CRD42021227574.
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Affiliation(s)
- Maria-Markella Gounari
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Tsaousi
- Department of Anesthesiology and Critical Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki,, Thessaloniki, Greece.
| | - Lampros Zouloumis
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pergolizzi JV, Breve F, Magnusson P, LeQuang JK, Varassi G. Current and emerging COX inhibitors for treating postoperative pain following oral surgery. Expert Opin Pharmacother 2023; 24:347-358. [PMID: 36562415 DOI: 10.1080/14656566.2022.2161364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The numerous drugs in the NSAID class are often used to treat acute postoperative pain associated with oral surgery such as impacted third-molar extractions. These drugs are effective in this setting and dental pain studies often serve as models for acute pain relief and for registration of analgesics. With numerous cyclooxygenase (COX) inhibitors available as monotherapy, for use in combination with analgesic regimens, and in different doses and formulations, it was our aim to determine if there were clear-cut distinctions among these products and dosing regimens. AREAS COVERED This is a literature review of recent randomized controlled clinical trials evaluating NSAIDs for use in postoperative pain management following oral surgery. Of particular interest were head-to-head studies, which might offer some insight into comparative effectiveness. EXPERT OPINION Postoperative oral surgery pain is largely managed in real-world clinical practice using NSAIDs, either alone or in combination, and there is good evidence supporting their use especially in multimodal therapy. Head-to-head and comparative studies do not show a clear-cut 'optimal NSAID' in this setting, although ibuprofen, ketoprofen, dexketoprofen, and naproxen have gained most acceptance. Combination therapy with other analgesics or adjuvants is largely accepted.
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Affiliation(s)
| | - Franklin Breve
- Department of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Peter Magnusson
- School of Medicine, Orebro University, Örebro, SWE
- Cardiology, Center of Research and Development Region Gävleborg /Uppsala University, Gävle, SWE
- Medicine, Cardiology Research Unit, Karolinska Institutet, SWE, Sweden
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Muthuluri T, Chandrupatla SG, Rajan R, Reddy VV, Jhawar DK, Potturi A. Pre-emptive analgesia efficacy of piroxicam versus tramadol in oral surgery. J Dent Anesth Pain Med 2022; 22:443-450. [PMID: 36601129 PMCID: PMC9763819 DOI: 10.17245/jdapm.2022.22.6.443] [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: 07/19/2022] [Revised: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background This double-blind randomized controlled trial (RCT) was conducted to evaluate the pre-emptive analgesia and anti-inflammatory efficacy of piroxicam compared with tramadol in patients undergoing oral surgery. Methods Seventy-eight patients who required extraction of impacted mandibular third molars were randomized into three treatment groups of 26 patients each: group I received 100 mg of tramadol, group II received 20 mg of piroxicam, and group III received a placebo. Drugs were administered intramuscularly 30 min prior to the extraction procedure. Results Pain intensity, time to first analgesic administration, total analgesic consumption, facial edema, and trismus were the outcomes of interest. The group receiving 20 mg of piroxicam showed significantly lower pain intensity, increased time to first analgesic, and reduced edema from preoperative to postoperative day seven than those in the tramadol and placebo groups. Conclusion The findings of this study showed that piroxicam had significant pain relief efficacy after third molar surgery compared with that in tramadol.
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Affiliation(s)
- Tejdeep Muthuluri
- Department of Oral & Maxillofacial Surgery, SVS Institute of Medical & Dental Sciences, Mehaboobnagar, TG, India
| | | | - Ritesh Rajan
- Department of Oral & Maxillofacial Surgery, SVS Institute of Medical & Dental Sciences, Mehaboobnagar, TG, India
| | - Viveka V. Reddy
- Department of Oral & Maxillofacial Surgery, SVS Institute of Medical & Dental Sciences, Mehaboobnagar, TG, India
| | - Dinesh K. Jhawar
- Department of Oral & Maxillofacial Surgery, SVS Institute of Medical & Dental Sciences, Mehaboobnagar, TG, India
| | - Abhinand Potturi
- Department of Oral & Maxillofacial Surgery, SVS Institute of Medical & Dental Sciences, Mehaboobnagar, TG, India
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Sarvari HR, Baigrezaii H, Nazarianpirdosti M, Meysami A, Safari-Faramani R. Comparison of the efficacy of intranasal ketamine versus intravenous ketorolac on acute non-traumatic headaches: a randomized double-blind clinical trial. Head Face Med 2022; 18:1. [PMID: 34980184 PMCID: PMC8722273 DOI: 10.1186/s13005-021-00303-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Non - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches. METHODS This randomized and double-blind clinical trial was conducted in 2019. One hundred and forty samples were randomly divided into intranasal ketamine (A) and intravenous ketorolac (B). Group (A) received ketamine intranasal (0.75 mg/kg, max 75 mg), and group B received intravenous ketorolac (30 mg). Headache severity was measured on arrival, 30, 60, and 120 min after intervention with Visual Analogue Scale (VAS). The side effects were recorded an hour after the intervention. RESULT The mean difference of pain intensity 30, 60, and 120 min after the intervention between the two groups was statistically significant (p < 0.001). In the first 30 min, significant changes were observed in the VAS levels of the two groups. These changes were significantly greater in the intranasal ketamine group (p < 0.001). Side effects such as fatigue, dizziness, general discomfort, nausea, increased heart rate, and hypertension were significantly higher in the ketamine group (p < 0.05). CONCLUSION Intranasal ketamine and intravenous ketorolac both effectively reduced headaches. However, more analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches. TRIAL REGISTRATION IRCT20180108038276N3 , Registered 29 September 2019. ETHICS COMMITTEE REFERENCE NUMBER IR.KUMS.REC.1398.068.
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Affiliation(s)
- Hooman Rafiei Sarvari
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamidreza Baigrezaii
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amirhossein Meysami
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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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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Tirupathi S, Rajasekhar S, Maloth SS, Arya A, Tummalakomma P, Lanke RB. Pre-emptive analgesic efficacy of injected ketorolac in comparison to other agents for third molar surgical removal: a systematic review. J Dent Anesth Pain Med 2021; 21:1-14. [PMID: 33585680 PMCID: PMC7871182 DOI: 10.17245/jdapm.2021.21.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 01/02/2023] Open
Abstract
This study aimed to evaluate and compare the pre-emptive analgesic efficacy of injected ketorolac to that of other agents for impacted third molar surgical removal in a healthy population. PubMed, Ovid SP, Cochrane databases were filtered from 1980 to July 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria independently by reviewers. Studies that compared pre-emptive intramuscular or intravenous administration of ketorolac to other agents were evaluated. The outcomes sought were self-reported postoperative pain (patient-perceived pain), median duration for rescue analgesic medication, total number of analgesics consumed in the recovery period, and global assessment (overall patient satisfaction) after the recovery period. Six studies were included in the final evaluation. The outcome of pain perception and the number of analgesics taken were significantly lower in the ketorolac group (intramuscular or intravenous) in most of the studies (n=5) than in the group of other drugs. The mean time for rescue analgesia intake was higher for the ketorolac group, and global assessment scores were also better in the ketorolac group. Although the included studies show significantly better outcomes such as postoperative pain, median time taken for rescue medication, total number of analgesics taken, and overall patient satisfaction with injected ketorolac group in comparison to injected diclofenac, dexamethasone, and tramadol, definitive conclusions cannot be made regarding the superiority of injected Ketorolac as a pre-emptive agent. A greater number of randomized control trials with a proper protocol are needed to make definitive conclusions.
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Affiliation(s)
- Sunnypriyatham Tirupathi
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Srinitya Rajasekhar
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | | | - Aishwarya Arya
- Department of Periododntics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Pushpalatha Tummalakomma
- Department of Periododntics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
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Pathi J, Vidya KC, Sangamesh NC. Tramadol versus ketorolac for pain management after third molar surgery. Natl J Maxillofac Surg 2020; 11:236-240. [PMID: 33897187 PMCID: PMC8051645 DOI: 10.4103/njms.njms_78_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/18/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives: To compare the analgesic efficacy of preoperative intravenous (IV) ketorolac versus tramadol in preventing postoperative pain after mandibular third molar surgery. Methodology: Two hundred patients in the age group of 18–40 years with asymptomatic impacted mandibular molars were randomly allocated into one of the two groups (100 in each group) and underwent third molar surgery under local anesthesia. Group I received IV ketorolac 30 mg and Group II received IV tramadol 50 mg preoperatively. The difference in postoperative pain was assessed by five primary end points: pain intensity being measured hourly by Wong-Baker pain assessment scale for 6 h, onset of analgesia, duration of action, total number of analgesics consumed, and patient's global assessment. Results: Throughout the 6 h investigation period, patients reported significantly lower pain intensity scores, longer duration of action, lesser postoperative analgesic consumption, and better global assessment in ketorolac when compared to tramadol group. Patients in the ketorolac group significantly performed better than the tramadol group in terms of all parameters except onset of analgesia. All the drug-related complications were mild and did not require any investigation. Conclusion: The result of the present study shows that preoperative IV ketorolac 30 mg is more effective than tramadol 50 mg for postoperative pain following third molar surgery.
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Affiliation(s)
- Jugajyoti Pathi
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - K C Vidya
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - N C Sangamesh
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
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Dubey T, Singh M, Sharma A, Laskar S, Vashistha A. Combination of Articaine and Ketamine V/S Articaine Alone After Surgical Extraction of Impacted Third Molars. Ann Maxillofac Surg 2020; 10:42-46. [PMID: 32855913 PMCID: PMC7433971 DOI: 10.4103/ams.ams_143_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/14/2022] Open
Abstract
Objective: Local anesthetics are the most effective drugs available for the management of pain while performing operative procedures. This study was performed to compare the clinical efficacy of treatment with local anesthetic articaine (4%) with ketamine and local anesthetic articaine alone (4%) for the relief or prevention of postoperative pain, swelling, and trismus after the surgical extraction of impacted mesioangular third molars. Materials and Methods: Sixty patients undergoing the extraction of impacted mesioangular mandibular third molars were included in the study. The patients were randomly divided into two groups: local anesthetic alone (LAA) and local anesthetic plus ketamine (LAK). Results: Facial swelling following surgery on postoperative days was significantly lower in the LAK group than in the LAA group on 3rd and 7th postoperative days (P < 0.05). Mouth opening on the postoperative days was significantly greater in the LAK group than in the LAA group on 3rd and 7th postoperative days (P < 0.05). The pain scores on the visual analog scale at 30 min and 1 h, 4 h, 12 h, and 24 h after the surgery were significantly higher in the LAA group than in the LAK group and there was no significant difference in heart rate, oxygen saturation, and blood pressure in both the groups. Conclusion: In this present study, the effect of articaine with ketamine in comparison with articaine alone intraoperatively and postoperatively was observed, and it revealed that the combination of articaine with ketamine produced good local anesthesia and provide good postoperative analgesia with less swelling and significantly less trismus.
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Affiliation(s)
- Tushar Dubey
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Manpreet Singh
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Ashish Sharma
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Shyamalendu Laskar
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Arpit Vashistha
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
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Kale SG, Shetty A, Moin A, Archana TS, Kumar P, Bagga V. Comparative Evaluation of Preemptive Analgesia of Dextromethorphan and Ibuprofen in Third Molar Surgeries. Ann Maxillofac Surg 2020; 10:312-319. [PMID: 33708573 PMCID: PMC7944010 DOI: 10.4103/ams.ams_252_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction: Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective. Objective: The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries. Material and Methods: Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively. Results: The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients. Conclusion: DM premedication is a viable preemptive analgesic in reducing postoperative pain.
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Affiliation(s)
- Saurabh Gajanan Kale
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Ayesha Moin
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - T S Archana
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Vivek Bagga
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
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Comparison of the Anesthetic Efficiency of Lidocaine and Tramadol Hydrochloride in Orthodontic Extractions: A Split-Mouth, Prospective, Randomized, Double-Blind Study. J Oral Maxillofac Surg 2020; 78:52-62. [DOI: 10.1016/j.joms.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
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Leitão CJ, Lima-Rodríguez JR, Ferreira F, Avelino C, Sánchez-Margallo FM, Antunes L. Parasympathetic Tone Activity Evaluation to Discriminate Ketorolac and Ketorolac/Tramadol Analgesia Level in Swine. Anesth Analg 2019; 129:882-889. [PMID: 31425233 DOI: 10.1213/ane.0000000000003573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Evaluation of nociceptive-antinociceptive balance during general anesthesia is still challenging and routinely based on clinical criteria. Analgesic drug delivered may be optimized with parasympathetic tone activity (PTA) monitor. This study compares ketorolac and ketorolac/tramadol balance analgesia using a PTA monitor. METHODS Pain intensity response was assessed using a 0-100 numerical state scale (PTA) after nociceptive stimuli in pigs under stable sevoflurane anesthesia. Bispectral index, heart rate, noninvasive blood pressure, and respiratory parameters were also measured. Animals were divided into 3 groups: without analgesia, ketorolac, and ketorolac/tramadol. Mean values or mean areas under the curve (AUC) in selected time periods were compared over time and between groups through a mixed-model repeated measures analysis of variance and nonparametric Kruskal-Wallis tests, followed by Bonferroni or Dunn's multiple comparisons. RESULTS It was observed a significant decrease in the PTA AUC mean value after application of the stimulus in animals treated without analgesia and only with ketorolac. The PTA AUC mean value in the control group was significantly lower than the corresponding mean in ketorolac group. The ketorolac/tramadol group showed the highest PTA AUC mean values, significantly different from those obtained for the other 2 groups, with no significant differences detected over time. Bispectral index means showed no statistically significant differences either over time periods or between different treatment groups. Heart rate showed only a statistically significant increase in AUC mean between without analgesia and ketorolac/tramadol group, in the time period after the stimulus application. Noninvasive blood pressure means showed no statistically significant differences over time and between treatment groups. CONCLUSIONS This study shows that a low dose combination of ketorolac and tramadol is sufficient to block the pain responses induced with a needle holder in pigs 20 minutes after its administration. The PTA monitor was able to clearly recognize the analgesic level between treatments and may be used to optimize analgesic drug delivered.
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Affiliation(s)
- Carlos J Leitão
- From the Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB)
- Department of Veterinarian Sciences, School of Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | | | - Fatima Ferreira
- Department of Mathematics, School of Science and Technology (ECT), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Center of Mathematics of the University of Minho - UTAD Pole (CMAT-UTAD), Vila Real, Portugal
| | - Catarina Avelino
- Department of Mathematics, School of Science and Technology (ECT), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Center of Mathematics of the University of Minho - UTAD Pole (CMAT-UTAD), Vila Real, Portugal
- Center for Computational and Stochastic Mathematics (CEMAT), Higher Technical Institute, University of Lisboa (IST-UL), University of Lisboa (IST-UL), Lisboa, Portugal
| | | | - Luís Antunes
- From the Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB)
- Department of Veterinarian Sciences, School of Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
- Institute of Research and Innovation in Health, University of Porto, Porto, Portugal
- Laboratory Animal Science Group, Institute of Molecular and Cellular Biology (IBMC), University of Porto, Porto, Portugal
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Degala S, Nehal A. Comparison of intravenous tramadol versus ketorolac in the management of postoperative pain after oral and maxillofacial surgery. Oral Maxillofac Surg 2018; 22:275-280. [PMID: 29845481 DOI: 10.1007/s10006-018-0700-3] [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: 10/26/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to assess the better postoperative analgesic, tramadol, and ketorolac, in patients with maxillofacial trauma and who had undergone maxillofacial surgery, i.e., open reduction internal fixation, under general anesthesia. MATERIALS AND METHODS After taking ethical approval from the institution and informed consent, 46 ASA grade I-II patients were block randomized (ABAB) based on inclusion and exclusion criteria and equally divided into two groups in which one group of patients was given intravenous tramadol 100 mg and another group of patients was given intravenous ketorolac 30 mg at the time of closure of skin and was repeated after 8 and 16 h following surgery. Pain using VAS at the 2nd, 4th, 6th, 12th, and 24th postoperative was assessed, and association of results was compared using Cramer's V test SPSS (Version 22). Vital signs and side effects were recorded. RESULTS Although both drugs resulted in significant decrease in pain intensity from the 2nd to 24th postoperative hour, intravenous tramadol always resulted in better pain control than intravenous ketorolac at every postoperative hour (p value < 0.05) except at 2nd hour where changes are non-significant (p value > 0.05). CONCLUSION Apart from first 2 h where the changes are non-significant, this study clearly demonstrates the advantage of the intravenous tramadol in the management of postoperative pain and ease of administration in postoperative patient through IV cannula. The side effects of both the drugs were insignificant and did not have any effect on the result.
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Affiliation(s)
- Saikrishna Degala
- Department of Oral and Maxillofacial Surgery, J.S.S. Dental College & Hospital (Constituent College), Jagadguru Sri Shivarathreeshwara University, 570015, Mysuru, Karnataka, India.
| | - Asad Nehal
- Department of Oral and Maxillofacial Surgery, J.S.S. Dental College & Hospital (Constituent College), Jagadguru Sri Shivarathreeshwara University, 570015, Mysuru, Karnataka, India
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Ege B, Calisir M, Al-Haideri Y, Ege M, Gungormus M. Comparison of Local Anesthetic Efficiency of Tramadol Hydrochloride and Lidocaine Hydrochloride. J Oral Maxillofac Surg 2018; 76:744-751. [DOI: 10.1016/j.joms.2017.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/05/2017] [Accepted: 11/05/2017] [Indexed: 11/27/2022]
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Wang TF, Wu YT, Tseng CF, Chou C. Associations between dental anxiety and postoperative pain following extraction of horizontally impacted wisdom teeth: A prospective observational study. Medicine (Baltimore) 2017; 96:e8665. [PMID: 29381942 PMCID: PMC5708941 DOI: 10.1097/md.0000000000008665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study is to identify associations between dental anxiety and postoperative pain in patients undergoing extraction of horizontally impacted wisdom teeth.A total of 119 volunteers provided demographic data, and completed questionnaires, the State-Trait Anxiety Inventory (STAI), Chinese Index of Dental Anxiety and Fear (C-IDAF)-4C, and the Numeric Rating Scale (NRS) for pain.Mean SAI, TAI, and C-IDAF-4C scores were 42.5 ± 8.7, 46.4 ± 10.9, and 16.9 ± 7.2, respectively. Mean postoperative pain level score was 3.0 ± 1.8 (range: 0.3-8.4). SAI scores increased as preoperative pain levels increased (β = 1.30, 95% confidence interval [CI]: 0.62-1.98, P < .001); females had higher SAI scores than males (5.34; 95% CI: 1.74-8.95, P = .004). Multivariable analysis revealed that females, bad exodontic experience, and higher predicted pain levels were associated with higher IDAF-4C scores. SAI scores (γ = 0.611, P < .001) and TAI scores (γ = 0.305, P < .001) increased as C-IDAF-4C scores increased. Higher C-IDAF-4C scores and longer operative time were significantly associated with higher levels of postoperative pain.Specific factors are associated with anxiety and stress, and postoperative pain in patients undergoing wisdom teeth extraction. Addressing these factors preoperatively may reduce stress and anxiety, and lead to more favorable treatment outcomes.
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Affiliation(s)
| | - Ya-Ting Wu
- School of Nursing, National Yang Ming University
| | - Chien-Fu Tseng
- Graduate Institute of Clinical Dentistry, School of dentistry, National Taiwan University
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Nezafati S, Khiavi RK, Mirinejhad SS, Ammadi DA, Ghanizadeh M. Comparison of Pain Relief from Different Intravenous Doses of Ketorolac after Reduction of Mandibular Fractures. J Clin Diagn Res 2017; 11:PC06-PC10. [PMID: 29207772 DOI: 10.7860/jcdr/2017/30946.10558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
Introduction Pain is an unpleasant feeling due to tissue destruction, which disturbs an individual's daily routines even at its lowest levels. The majority of surgeons and anaesthesiologists are increasingly trying to administer non-opioid analgesics because excessive use of opioids after surgery results in patient dissatisfaction. Aim To evaluate the analgesic effect of intravenous injection of different doses of ketorolac at different intervals in patients undergoing surgery for unilateral fractures of the mandible. Materials and Methods In the present randomized clinical trial (March 2016 to January 2017, in Tabriz Imam Reza Treatment/Educational Center), 50 patients were assigned to five groups with simple randomization method. In Group 1 and 2, immediately before the induction of general anaesthesia 30 and 60 mg of ketorolac and in Group 3 and 4, immediately before termination of surgery 30 and 60 mg of ketorolac was injected intravenously. In Group 5, ketorolac was not administered. After each patient regained complete consciousness, the severity of pain was determined using VAS up to 24 hours at baseline and at 2, 4, 6, 12 and 24-hours intervals. The total dose of the opioid analgesic agent (morphine-pethidine) and the time for the first request for an analgesic agent were recorded for each patient and their means were compared in each group with suitable statistical tests. Results The patients in Group 5 and 4 exhibited the highest and lowest mean pain scores (5.03±0.9 and 3.5±1), respectively. ANOVA for repeated measures and post-hoc Tukey tests showed significant differences only between Group 3 and 5 (p=0.002) and Group 4 and 5 (p=0.001), with no significant differences between the other groups (p>0.005). The highest dose of the analgesic agent was in Group 5 (5.3±1.4 mg) and the lowest dose was recorded in Group 4 (1.6±0.6 mg). Patients in the control group received significantly higher doses compared to the other groups (p<0.05). The patients in Group 1 and 2 received higher doses of analgesics compared to Group 3 and 4 (p<0.05). The longest time for the request for the first dose of analgesic agent after surgery was 73.4±12.03 minutes in Group 4 The patients in the control group had requested analgesics after surgery at a significantly shorter time compared to the patients in all the study groups (p<0.05). The patients in Group 1 and 2 had requested analgesics at a shorter time after surgery compared to the subjects in Group 3 and 4 (p<0.05). Conclusion Intravenous administration of 30 and 60 mg of ketorolac, immediately before termination of surgery, decreases the pain severity and the need for opioid analgesics after surgery.
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Affiliation(s)
- Saeed Nezafati
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Azadi Street, Iran
| | - Reza Khorshidi Khiavi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Azadi Street, Iran
| | - Seyyed Sina Mirinejhad
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Azadi Street, Iran
| | - Dawood Aghamoh Ammadi
- Associate Professor, Department of Anaesthesiology, Tabriz University of Medical Sciences, Tabriz, Azadi Street, Iran
| | - Milad Ghanizadeh
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Tabriz University of Medical Sciences, Tabriz, Azadi Street, Iran
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Astramskaitė I, Juodžbalys G. Scales used to rate adult patients' psycho-emotional status in tooth extraction procedures: a systematic review. Int J Oral Maxillofac Surg 2017; 46:886-898. [PMID: 28377143 DOI: 10.1016/j.ijom.2017.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/27/2016] [Accepted: 03/10/2017] [Indexed: 12/14/2022]
Abstract
The aim of this study was to review scales used to assess anxiety, stress, and pain in dental patients undergoing a tooth extraction procedure and to propose a novel psycho-emotional rating scale based on the relevant literature and our own experience. An electronic literature search was conducted of the National Library of Medicine database MEDLINE (Ovid) and EMBASE databases between January 2005 and April 2016. Sequential screening at the title/abstract and full-text levels was performed. The review included all human prospective or retrospective follow-up studies and clinical trials, cohort studies, case-control studies, and case series that demonstrated at least one scale used to measure tooth extraction anxiety, stress, or pain. The search resulted in 32 articles meeting the inclusion criteria. None of the studies were found to be suitable in evaluating patient's stress, pain, and fear at once. Also, no scales were found that included both the doctor's and the patient's rating. In a few studies, vital signs as psycho-emotional status indicators were rated. Guidelines for a suitable questionnaire that could be used for rating the psycho-emotional status of patients undergoing tooth extraction are listed in the present research. Further studies are required for verification and validation of offered scale.
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Affiliation(s)
- I Astramskaitė
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - G Juodžbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Galar-Martínez M, García-Medina S, Gómez-Olivan LM, Pérez-Coyotl I, Mendoza-Monroy DJ, Arrazola-Morgain RE. Oxidative stress and genotoxicity induced by ketorolac on the common carp Cyprinus carpio. ENVIRONMENTAL TOXICOLOGY 2016; 31:1035-1043. [PMID: 25899151 DOI: 10.1002/tox.22113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 06/04/2023]
Abstract
The nonsteroidal anti-inflammatory drug ketorolac is extensively used in the treatment of acute postoperative pain. This pharmaceutical has been found at concentrations of 0.2-60 µg/L in diverse water bodies around the world; however, its effects on aquatic organisms remain unknown. The present study, evaluated the oxidative stress and genotoxicity induced by sublethal concentrations of ketorolac (1 and 60 µg/L) on liver, brain, and blood of the common carp Cyprinus carpio. This toxicant induced oxidative damage (increased lipid peroxidation, hydroperoxide content, and protein carbonyl content) as well as changes in antioxidant status (superoxide dismutase, catalase, and glutathione peroxidase activity) in liver and brain of carp. In blood, ketorolac increased the frequency of micronuclei and is therefore genotoxic for the test species. The effects observed were time and concentration dependent. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 1035-1043, 2016.
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Affiliation(s)
- M Galar-Martínez
- Departamento de Farmacia, Laboratorio de Toxicología Acuática, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - S García-Medina
- Unidad Analítica de la Unidad de Farmacología Clínica, Facultad de Medicina - UNAM, Nezahualcóyotl, Edo de México
| | - L M Gómez-Olivan
- Departamento de Farmacia, Facultad de Química, Laboratorio de Toxicología Ambiental, Universidad Autónoma del Estado de México, Toluca, México
| | - I Pérez-Coyotl
- Departamento de Farmacia, Laboratorio de Toxicología Acuática, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - D J Mendoza-Monroy
- Departamento de Farmacia, Laboratorio de Toxicología Acuática, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - R E Arrazola-Morgain
- Departamento de Farmacia, Laboratorio de Toxicología Acuática, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
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Isiordia-Espinoza MA, Pozos-Guillen A, Martinez-Rider R, Perez-Urizar J. Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial. Med Oral Patol Oral Cir Bucal 2016; 21:e637-43. [PMID: 27475688 PMCID: PMC5005104 DOI: 10.4317/medoral.21077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/30/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Preemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery. MATERIAL AND METHODS A parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects. RESULTS Patients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol. CONCLUSIONS According to the VAS and UAC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery.
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Affiliation(s)
- M-A Isiordia-Espinoza
- Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, Av. Dr. Manuel Nava #2, Zona Universitaria, C.P. 78290, San Luis Potosí, S.L.P. México,
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Mony D, Kulkarni D, Shetty L. Comparative Evaluation of Preemptive Analgesic Effect of Injected Intramuscular Diclofenac and Ketorolac after Third Molar Surgery- A Randomized Controlled Trial. J Clin Diagn Res 2016; 10:ZC102-6. [PMID: 27504398 DOI: 10.7860/jcdr/2016/17696.8045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Analgesia pre-emptively administered effect-ively aid in management of pain. Pre-emptive analgesia is anti-nociceptive treatment which prevents altered central sensitization of afferent inputs. AIM To compare and evaluate the pre-emptive analgesic efficacy of preoperatively administered ketorolac and diclofenac for controlling postoperative pain after third molar surgery. MATERIALS AND METHODS A total of 50 patients with symmetrically impacted third molars were divided into two groups, 30mg intramuscular injection of ketorolac and 75 mg diclofenac sodium were used in the respective groups. The visual analogue scale was used to assess post operative pain for three days and the patients were also evaluated for the number of rescue analgesia. RESULTS The data was statistically evaluated with paired t- test. The maximum time taken for pain perception for Group A Ketoralac was 5.48 hrs and Group B Diclofenac sodium was 4.9 hrs and p=0.235 which was not significant. The mean number of tablets taken by the patients in the first three post operative days was 3.24 in Group A i.e., Ketorolac and 4.04 in Group B i.e., Diclofenac sodium. The values were compared using the paired t test. The p value = 0.004, which was significant. CONCLUSION Ketoralac showed better pre-emptive analgesic effect for post-operative pain management after third molar extraction. The immediate post-operative pain free period provided by both ketorolac and diclofenac by intramuscular route was same.
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Affiliation(s)
- Deepthi Mony
- Lecturer, Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth , Pune, Maharashtra, India
| | - Deepak Kulkarni
- Professor and Head, Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth , Pune, Maharashtra, India
| | - Lakshmi Shetty
- Associate Professor, Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth , Pune, Maharashtra, India
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Gönül O, Satilmiş T, Ciftci A, Sipahi A, Garip H, Göker K. Comparison of the Effects of Topical Ketamine and Tramadol on Postoperative Pain After Mandibular Molar Extraction. J Oral Maxillofac Surg 2015; 73:2103-7. [DOI: 10.1016/j.joms.2015.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
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Drew SJ. Best Practices for Management of Pain, Swelling, Nausea, and Vomiting in Dentoalveolar Surgery. Oral Maxillofac Surg Clin North Am 2015; 27:393-404. [DOI: 10.1016/j.coms.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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