Effect of intravenous paracetamol as pre-emptive compared to preventive analgesia in a pediatric dental setting: a prospective randomized study

Effect of Preemptive Analgesia on Pain Perception in Children: A Randomized Controlled Trial

Background

Efforts have been made to minimize pain, prevent the development of needle fear, and promote positive experiences for children. The present study is designed to evaluate the effect of premedication with Ibugesic Plus before the administration of local anesthesia and extraction in children.

Aim

The aim of the study is to assess the efficacy of preemptive analgesia on pain perception during local anesthesia administration and extraction in pediatric patients.

Materials and methods

A total of 104 patients aged 7-10 years were selected who needed primary molar extraction. Group -Ibugesic Plus syrup was given 30 minutes prior to extraction. Group II-Placebo solution (B-Folcin syrup) was given 30 minutes prior to extraction. Pain level, pulse rate, and SpO2 were assessed using the Wong-Baker Faces Pain Rating Scale (WBFS) and pulse oximeter after injection, after extraction, and postoperatively.

Results

The highest scores of pain were recorded after the time of injection and extraction. The patients who received preemptive analgesics (group I) reported significantly less pain than the placebo group (group II) at the time immediately after injection, after extraction, and 2 hours after extraction.

Conclusion

The present study showed that preemptive analgesic administration may be considered a routine and rational pain management strategy in primary tooth extraction procedures in children.

Clinical significance

Preemptive analgesia can be given to patients prior to dental procedures to reduce postoperative pain.

How to cite this article

Virda M, Panda A, Kataria K. Effect of Preemptive Analgesia on Pain Perception in Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(8):913-917.

Is Paracetamol Better than Diclofenac Sodium in Management of Postoperative Pain and Edema Following Major Maxillofacial Surgeries?

Introduction

Paracetamol is an optimal non-opioid analgesic and holds considerable advantages over NSAIDs in managing post-operative pain. Literature to date doesn't provide substantial documentation of it's efficacy and safety in major oral and maxillofacial surgeries. The study is designed to compare the effectiveness of intravenous paracetamol with diclofenac sodium for controlling post-operative pain and edema in major oral and maxillofacial surgeries.

Method

The double-blind randomised prospective study includes 140 healthy patients with ASA grades I and II. Patients were divided into Group A (1gm paracetamol) and B (75 mg diclofenac sodium), 70 patients each, undergoing similar surgical procedures. VAS and VRS were assessed for pain and thread method for measuring swelling. Mouth opening in space infections was measured with calliper and scale.

Results

Independent samples t-test and chi-square test showed longer pain-free interval, more interval between first and second dose, lesser number of doses required in Group A than Group B (p-value < 0.05). Independent samples t-test and Mann-Whitney test showed faster resolution of swelling in Group A (p-value < 0.05). Independent samples t-test showed lesser time taken for resolution of trismus in space infections in Group A (p-value < 0.05).

Discussion

Paracetamol 1 g was found to be an effective analgesic with less adverse effects. It is superior non-opioid analgesic in reducing the intensity of post-operative pain and swelling, also requires less number of doses than diclofenac sodium in major surgeries. Patients treated with paracetamol had better quality of life during post-operative period.

Can paracetamol lower stress and anxiety by blunting emotions during and after computer guided dental implant surgeries? Findings from a randomized crossover clinical trial

BACKGROUND/PURPOSE

Dental implants insertion can be a major factor in stress and anxiety. The aim was to evaluate the paracetamol ability to lower stress and anxiety when compared with ibuprofen during and after computer guided implant surgery utilizing CAD/CAM surgical template and a computer vision system for assessment.

MATERIALS AND METHODS

Thirty patients were enrolled in a crossover study design having bilateral missing lower molars. Patients were randomized into 2 equal groups with the first assigned for dental implant insertion in the lower molar area on one side with the administration of paracetamol (with 7-day follow-up) followed by 2-week washout period, then another implant was inserted on the contra-lateral side with ibuprofen. The second group received the same drugs but in reversed order. Salivary cortisol level was used to measure anxiety and a computer vision system was used to measure swelling. Visual-Analogue-Scale pain score from 0-to-100 was also utilized.

RESULTS

Only 29 patients completed the study. Stress and anxiety was found to be significantly lower in paracetamol group (4.1 ± 1.08 ng/mL and 6.2 ± 0.94 ng/mL for paracetamol/ibuprofen respectively). Pain score was 13.1 ± 1.1 and 12.9 ± 2.3 in paracetamol/ibuprofen groups respectively with no significant differences. Swelling showed significant difference favoring the paracetamol group (0.91 ± 0.41 and 0.61 ± 0.31 for paracetamol/ibuprofen respectively).

CONCLUSION

Paracetamol is effective in reducing stress by minimizing anxiety and blunting emotions of "fear-from-pain" so that pain is no longer perceived as much. However, paracetamol lacks the ability to control swelling at implant site. Computer guided flapless-implant surgery with immediate loading can be recommended for fearful patients.

Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective, single-blind, randomized controlled trial

BACKGROUND

The efficacy of preemptive analgesia in managing postoperative pain remains controversial. The aim of this study was to compare the efficacy of intravenous (IV) acetaminophen administered before or immediately after the surgical extraction of an impacted mandibular third molar.

MATERIAL AND METHODS

This prospective randomized clinical trial included 120 patients. The patients were assigned to one of three groups: the preoperative-treatment group (pre-group), which received 1000 mg of IV acetaminophen 20 min before surgery; the postoperative-treatment group (post-group), which received 1000 mg of IV acetaminophen after surgery; the no-treatment group (control-group), which did not receive any analgesic. Rescue analgesic (60 mg loxoprofen) was issued to each patient, with instructions on self-administration if needed. For the rescue medication usage, the time of first loxoprofen usage and the total amount of loxoprofen consumption were obtained for a 17-hour period after surgery. We measured pain using the visual analogue scale at 1 hour and at 2, 3, 4, 5, and 15 hours after surgery.

RESULTS

There was no significant difference in pain level among the three groups at any time interval. However, the pre-group demonstrated significantly lower rescue analgesic consumption and longer time until initial administration.

CONCLUSIONS

Administration of IV acetaminophen before third molar surgery provides more effective pain control than postoperative administration and no treatment.

Guidelines for reporting randomized controlled trials in paediatric dentistry based on the CONSORT statement

BACKGROUND

The significance of randomized controlled trials (RCT) depends on how thoroughly the results were reported. Reporting of RCTs should be accurate and transparent and encompasses design, implementation, analysis, and results of the trial. The Consolidated Standards of Reporting Trials (CONSORT) statement and its extension were developed to guide the researchers to report clinical trials in a systematic manner. Despite this recommendation, the overall reporting quality of RCTs still remains suboptimal.

AIM

To describe the relevance and importance of CONSORT reporting guidelines and explain the items using examples derived from randomized trials published in Paediatric Dentistry.

METHODS

This is a narrative review that illustrates the importance of reporting items in the CONSORT guidelines from relevant sources. RCTs published in the International Journal of Paediatric Dentistry between 2017 and 2020 were identified from PubMed and Scopus databases and through handsearching. An explanation has been provided for each of the 37 items in the 2010 CONSORT checklist and 17 items in the CONSORT extension for reporting abstracts.

CONCLUSION

This explanation and elaboration document would enable investigators to report trials in Paediatric Dentistry with accuracy and transparency as well as for reviewers and editors in evaluating the suitability of RCTs for publication.

Post-operative pain and morbidity in children who have tooth extractions under general anaesthesia: a service evaluation

Introduction Children find dental extractions under general anaesthesia (GA) painful despite national analgesic guidelines.Aims To report on children's post-operative pain, morbidity, families' satisfaction and analgesic regime during GA dental extractions.Design A prospective service evaluation.Setting King's College Hospital, London.Methods Children (n = 143) self-reported pain using the Faces Pain Scale-Revised (FPS-R) pre- and post-operatively and one week later by telephone as reported by the child's parent/carer. Morbidity was assessed using the Morbidity Checklist & Post Hospital Behaviour Questionnaire and each family's satisfaction using the Treatment Evaluation Inventory.Results Children were a mean age of six years and had seven primary teeth extracted. When given intravenous (IV) fentanyl (n = 69), either alone (n = 11) or in combination with paracetamol (n = 58) the children had 0.17 times odds of not having post-op pain compared to patients who received only paracetamol (logistic regression, p = 0.006). After one week 99% of families were satisfied with the service but 11% reported that their child still had post-operative morbidity.Conclusion Three quarters of children reported pain following extractions of primary teeth under GA. Use of IV paracetamol and fentanyl reduced the immediate post-operative self-reported pain. After a week most families (99%) were satisfied with the treatment their child had received and morbidity was reported by 11% of families.

Effects of pre-emptive analgesia on efficacy of buccal infiltration during pulpotomy of mandibular primary molars: a double-blinded randomized controlled trial

Objective: To assess the effect of preoperative administration of ibuprofen and acetaminophen on the efficacy of buccal infiltration for pulp therapy in mandibular primary molars. Materials and methods: A randomized controlled trial with an ID no. NCT03423329 in Clinical-Trials.gov was conducted in the outpatient clinic of Paediatric Dentistry Department at Ain Shams University. The study was designed with two test arms where either ibuprofen or acetaminophen was administered to children whereas in the control arm a multivitamin placebo was used. Children's self-reported pain responses were recorded using Wong-Baker FACES pain scale. For statistical analysis, Chi-square test or Fisher's exact test was used to compare between the three groups whereas Friedman's test was used to study changes within each group. Results: In a sample of 60 children, a significant decrease in the mean pain rating scores was detected in all groups where success rates ranged from 40% with ibuprofen to 55% and 65% with acetaminophen and placebo, respectively. However, there was no statistically significant difference between the three groups regarding severity of pain during access cavity preparation. Conclusions: Both analgesics have no clinical advantage over the placebo in increasing the efficacy of buccal infiltration during pulp therapy in mandibular primary molars.