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Topan C, Karakaya M, Demirbaş AE, Bilge S, Canpolat DG. PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY. J Evid Based Dent Pract 2024; 24:101957. [PMID: 38448122 DOI: 10.1016/j.jebdp.2023.101957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. MATERIALS AND METHODS One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. RESULTS The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030). CONCLUSION Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.
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Affiliation(s)
- Cihan Topan
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
| | - Mustafa Karakaya
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Ahmet Emin Demirbaş
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Suheyb Bilge
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Dilek Günay Canpolat
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
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Sellami M, Zouche I, Ben Ayed M, Bouhali M, Ben Ayed K, Ktata S, Hammami B, Chaabouni MA, Charfeddine I. Ketamine infiltration improves analgesia after thyroid surgery. F1000Res 2023; 12:206. [PMID: 38314321 PMCID: PMC10835105 DOI: 10.12688/f1000research.127562.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 02/06/2024] Open
Abstract
Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.
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Affiliation(s)
- Moncef Sellami
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Zouche
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariam Ben Ayed
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Maroua Bouhali
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Khadija Ben Ayed
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Ktata
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Boutheina Hammami
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ilhem Charfeddine
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
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Myers AL, Jeske AH. Provider-directed analgesia for dental pain. Expert Rev Clin Pharmacol 2023; 16:435-451. [PMID: 37083548 DOI: 10.1080/17512433.2023.2206118] [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: 04/22/2023]
Abstract
INTRODUCTION Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry. AREAS COVERED This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain. EXPERT OPINION Substantial evidence-based literature shows combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) when short-course opioid prescription is appropriate in select patients, in which a 2-3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.
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Affiliation(s)
- Alan L Myers
- Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arthur H Jeske
- Office of the Dean, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Dutta S, Kumar RM, Kumar KRA, Marimallappa TR, Pal S, Rao K. A Clinical Study for Removal of Impacted Mandibular Third Molar under Local Anaesthesia, with and without Ketamine - A Split Mouth Comparative Study. Ann Maxillofac Surg 2023; 13:64-69. [PMID: 37711519 PMCID: PMC10499295 DOI: 10.4103/ams.ams_241_22] [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: 12/20/2022] [Revised: 03/26/2023] [Accepted: 04/27/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Disimpaction is one of the most common operations done by oral and maxillofacial surgeons around the world. Ketamine is a well-known general anaesthetic and short-acting intraoperative analgesic. The aim of this study was to measure the efficacy of anaesthesia using combined treatment with local anaesthetic plus a subanaesthetic dose of ketamine and local anaesthetic alone in bilaterally impacted mandibular third molar surgery. Methods and Materials A total of 24 patients who consented were taken up for a split-mouth study. In the control group, surgical extraction of the impacted lower third molar was done using local anaesthesia (lignocaine 2% with 1:80,000 adrenaline) only, and in the study group, local anaesthesia with ketamine extraction was done using ketamine (0.2 mg/kg) along with local anaesthesia (LA). The time of onset and the duration of anaesthesia intraoperatively were recorded using a digital stopwatch. The depth of anaesthesia was noted on the 10th, 30th and 60th min. After extraction, the post-operative pain on the first, fourth, eighth and 12th hour was evaluated using a Visual Analogue Scale (VAS) score rating of 1-10. The pulse was also noted and compared for any differences in either of the groups. Results A statistically significant (P < 0.005) difference in result was obtained for the onset, duration, depth and pain score after surgical extraction in both the evaluated groups. The pain index score by the ketamine group was significantly low as compared to the local anaesthesia-only group. Intraoperative onset, duration and depth of anaesthesia obtained had a significant difference. Discussion Ketamine can be used as a viable option for surgical third molar extractions with reduced discomfort and post-operative pain.
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Affiliation(s)
- Subham Dutta
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - R. Mahesh Kumar
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - K. R. Ashok Kumar
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - T. R. Marimallappa
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - Supriyo Pal
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
| | - Keerthana Rao
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
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Reyes-Fernández S, García-Verónica A, Hernández-Treviño N, Cobos-Cruz XT, Serna-Radilla VO, Romero-Castro NS. Submucosal and intramuscular dexamethasone for the control of pain, trismus and edema after third molar surgeries: ¿Is it necessary? ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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