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Falci SGM, Fernandes IA, Guimarães MTBÁ, Galvão EL, de Souza GM, Al-Moraissi EA. Complementary and alternative therapies for managing postoperative pain after lower third molar surgery: a systematic review and network meta-analysis. Clin Oral Investig 2024; 28:231. [PMID: 38538810 DOI: 10.1007/s00784-024-05625-2] [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: 11/23/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of complementary and alternative treatments on postoperative pain following lower third molar surgeries. METHODS A comprehensive search of Electronic databases (Embase, MEDLINE via PubMed, and Cochrane Library) and grey literature was conducted up until May 2022. Randomized clinical trials investigating the effect of acupuncture, ozone therapy, laser (LLLT), drainage tube, kinesio-taping, ice therapy, and compressions on pain after LTM surgeries were included. The estimated mean differences (MD) for alternative therapies were pooled using the frequentist approach to random-model network meta-analysis NMA. RESULTS Eighty-two papers were included in the qualitative analysis; 33 of them were included in the quantitative analyzes. NMA revealed that drainage tube and kinesio-taping were superior in controlling pain 24-hours postoperatively than no-treatment. At 48-hours follow-up, kinesio-taping and LLLT more effective than placebo and drainage tube; and kinesio-taping and LLLT were superior to no treatment. At 72 h postoperatively, ozone therapy was superior to placebo; and drainage tube, kinesio-taping, and LLLT were better than no treatment. At 7-days follow-up, ozone and LLLT were superior to placebo; and LLLT and kinesio-taping were superior to no treatment. The SUCRA-ranking placed drainage tube as top-ranking intervention at 48-hours (98.2%) and 72-hours (96%) follow-ups, and ozone (83.5%) at 7-days follow-up. CONCLUSION The study findings suggest that these alternative and complementary therapies may be useful in reducing postoperative pain after LTM surgeries, and may offer advantages when combined to traditional pain management methods. CLINICAL RELEVANCE Non-pharmacological therapies are gaining popularity among healthcare professionals and patients. This study found that some of these therapies, specifically kinesio-taping and drainage tube were effective in controlling postoperative pain after third molar surgeries. These findings have important implications for clinical practice, as they highlight the potential benefits of incorporating these therapies into postoperative pain management plans.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
| | - Ighor Andrade Fernandes
- Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | - Endi Lanza Galvão
- Department of Physiotherapy, Federal University of Vales do Jequitinhonha e Murcuri, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
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Poorna P, Shetty P, Kalyani V, Shetty S, Upadya M, Mithra P. A comparative evaluation of the effect of addition of 8 mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study. FRONTIERS IN ORAL HEALTH 2024; 5:1349832. [PMID: 38404531 PMCID: PMC10884295 DOI: 10.3389/froh.2024.1349832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Background Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially. Aim To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars. Methodology A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures. Results Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7. Conclusion The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.
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Affiliation(s)
- P. Poorna
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Veerbhadra Kalyani
- Department of Oral Oncosurgery, VTSM Peripheral Cancer Centre, Kalaburagi, India
| | - Sameep Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Madhusudan Upadya
- Department of Emergency Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Miroshnychenko A, Azab M, Ibrahim S, Roldan Y, Diaz Martinez JP, Tamilselvan D, He L, Urquhart O, Verdugo-Paiva F, Tampi M, Polk DE, Moore PA, Hersh EV, Brignardello-Petersen R, Carrasco-Labra A. Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis. J Am Dent Assoc 2023; 154:727-741.e10. [PMID: 37500235 PMCID: PMC10910594 DOI: 10.1016/j.adaj.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients undergoing surgical tooth extractions of mandibular third molars. TYPES OF STUDIES REVIEWED The authors conducted a systematic review and meta-analysis. The authors searched the Epistemonikos database, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the US clinical trials registry (ClinicalTrials.gov) from inception until April 2023. Pairs of reviewers independently screened titles and abstracts, then full texts of trials were identified as potentially eligible. After duplicate data abstraction, the authors conducted random-effects meta-analyses. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool and certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Forty randomized controlled trials proved eligible. The evidence suggested that corticosteroids compared with a placebo provided a trivial reduction in pain intensity measured 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty) and 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty). The authors found no important difference between corticosteroids and a placebo with regard to incidence of postoperative infection (risk difference, 0%; 95% CI, -1% to 1%; low certainty) and alveolar osteitis (risk difference, 0%; 95% CI, -3% to 4%; very low certainty). PRACTICAL IMPLICATIONS Low and very low certainty evidence suggests that there is a trivial difference regarding postoperative pain intensity and adverse effects of corticosteroids administered orally, submucosally, or intramuscularly compared with a placebo in patients undergoing third-molar extractions.
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Satyanarayana Killampalli DYV, Yuwanati M, Krishnan M, Kumar SP, George M, Lakshmanan S. Preemptive Analgesic Efficacy of Dexamethasone and Diclofenac in Mitigating Post-surgical Complications After Mandibular Third-Molar Surgery: A Systematic Review. Cureus 2023; 15:e42709. [PMID: 37654946 PMCID: PMC10468144 DOI: 10.7759/cureus.42709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
Mandibular third-molar extraction is a frequently executed minor oral surgical procedure, with a subsequent recovery period lasting several days. Typically, preemptive administration of non-steroid anti-inflammatory drugs (NSAIDs) and steroids has been employed, resulting in a notable decrease in postoperative complications like pain, facial swelling, trismus, and alveolar osteitis. This systematic review's primary goal was to investigate the efficacy of preemptive analgesia with dexamethasone and diclofenac in minimizing the post-surgical complications following the surgical extraction of the mandibular third molars. The systematic search was carried out to identify relevant literature in digital databases including PubMed®, Cochrane Library, Web of Science, and Scopus, from January 1990 to January 2022. The search used specific keywords. The randomized clinical trials assessing the efficacy of dexamethasone and diclofenac or dexamethasone alone compared to diclofenac or placebo as preemptive analgesics were considered inclusion criteria for this systematic review. Case reports, literature reviews, letters to the editor, and non-English publications were not included. Two authors screened the titles and abstracts, and articles fulfilling the study criteria were included. After reading the full text and data collection, analysis was performed. The included article's bias was evaluated by the Risk of Bias 2 (RoB 2) tool. A digital database search yielded a total of 207 articles. After excluding duplicates and articles written in languages other than English, 90 were removed. Based on the title and abstract, out of 177, 95 studies were excluded. After full-text reading of 22 articles, 17 were eliminated because they did not meet the inclusion and exclusion criteria. The remaining five studies were found eligible and included in the systematic review. Four studies were of low risk, while one study had some concerns. Two studies evaluated the combination of dexamethasone with diclofenac, while three evaluated dexamethasone alone. Total samples included samples of 436 third-molar surgeries in 420 patients. There was a substantial decrease in the mean pain score and swelling measurement when diclofenac alone was compared with coadministration of diclofenac and dexamethasone. Preemptive administration of dexamethasone and diclofenac has been shown to effectively reduce pain and facial swelling, with the exception of trismus, in third-molar surgeries when compared to diclofenac alone. As a result, it is recommended to administer these drugs prior to the commencement of third-molar extraction. However, further research is mandatory, specifically good quality randomized controlled trials involving large cohorts, in order to assess any significant variations and validate these findings.
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Affiliation(s)
| | - Monal Yuwanati
- Oral Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Melvin George
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Saravanan Lakshmanan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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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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Massuda CKM, de Carvalho MR, de Moraes JB, Pallos D, Kim YJ. Accuracy of guided dental implant surgery using a fully digital workflow: A case series. J Prosthet Dent 2022:S0022-3913(22)00635-7. [PMID: 36372587 DOI: 10.1016/j.prosdent.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
STATEMENT OF PROBLEM Computer-guided implant surgery facilitated by intraoral scanning may enhance the efficiency of the digital workflow. However, it is necessary to assess technique accuracy to evaluate the accuracy of implant placement. PURPOSE The purpose of this clinical study was to evaluate the accuracy of a virtual computer-aided design and computer-aided manufacturing (CAD-CAM) static guided surgery technique associated with intraoral scanning in partially edentulous participants by analyzing the overlap among preoperative and postoperative cone beam computed tomography (CBCT) scans, virtual planning, and the guided surgery performed. MATERIAL AND METHODS Eleven partially edentulous participants underwent CBCT and intraoral scanning (TRIOS3). Data were integrated into a software program (ImplantViewer 3.5) for the virtual planning of implants and 3-dimensional (3D) printing of the prototype CAD-CAM surgical guide. A total of 18 implants were placed using the CAD-CAM static computer-aided implant surgery technique (Strong SW). After 15 days, postoperative CBCT scans were made and 4 variables (angular, coronal, apical, and vertical deviation) were measured to compare the virtually planned implants and the implants placed by analyzing the overlap between preoperative and postoperative of the virtual planning and guided surgery performed using the ImplantViewer 3.5 and Rhino 6 software programs. RESULTS Deviations were found in all parameters analyzed. The mean angular deviation was 2.68 ±1.62 degrees; mean coronal deviation, 0.82 ±0.44 mm; mean apical deviation, 1.14 ±0.44 mm; and mean vertical deviation, 0.62 ±0.44 mm. CONCLUSIONS The implants placed using the CAD-CAM static guided surgery technique associated with intraoral scanning in partially edentulous participants exhibited angular and linear deviations when compared with virtual planning implants. However, these deviations were not clinically significant.
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Affiliation(s)
| | | | - João Baptista de Moraes
- PhD student, Oral Rehabilitation Post-Graduation Program, Veiga de Almeida University, UVA, Rio de Janeiro, RJ, Brazil
| | - Débora Pallos
- Professor, Department of Implantology, University of Santo Amaro, UNISA, São Paulo, SP, Brazil
| | - Yeon Jung Kim
- Professor, Department of Implantology, University of Santo Amaro, UNISA, São Paulo, SP, 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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Shibl M, Ali K, Burns L. Effectiveness of pre-operative oral corticosteroids in reducing pain, trismus and oedema following lower third molar extractions: a systematic review. Br Dent J 2021:10.1038/s41415-021-3165-y. [PMID: 34239059 DOI: 10.1038/s41415-021-3165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022]
Abstract
Aim To determine if a single pre-operative dose of oral corticosteroids would be effective in reducing pain, trismus and oedema following lower third molar surgical extraction. Secondary outcomes of interest were post-operative complications such as infections.Methods Searching was conducted using Embase, Medline, DOSS, CINAHL and CENTRAL for randomised controlled trials. Four studies which compared pre-operative oral corticosteroids to placebo before lower third molar surgical extractions were eligible for inclusion.Results All studies were judged to be at unclear risk of bias. All studies tested the efficacy of 8 mg dexamethasone 60-90 minutes before surgical extractions. While three studies showed improvement in pain visual analogue scale (VAS) scores in the dexamethasone groups, two were not statistically significant. One study found no improvement in pain scores on VAS. One study found no difference in either trismus or oedema. One study reported one occurrence of post-operative alveolar infection in the dexamethasone group and one occurrence of alveolar osteitis in the placebo group.Conclusion While there seems to be an improvement in pain scores on VAS, these results are not clinically significant. Post-operative analgesia plays a more important role clinically.
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Affiliation(s)
- Mohammed Shibl
- Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK.
| | - Kamran Ali
- Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK
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Selvido DI, Bhattarai BP, Rokaya D, Niyomtham N, Wongsirichat N. Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management. Eur J Dent 2021; 15:588-598. [PMID: 34041732 PMCID: PMC8382502 DOI: 10.1055/s-0041-1725212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.
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Affiliation(s)
- Diane Isabel Selvido
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Dinesh Rokaya
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
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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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11
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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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Santos BFE, Costa FO, Pinto Júnior AAC, Araújo AVA, Cyrino RM, Cota LOM. Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial. J Craniomaxillofac Surg 2021; 49:694-704. [PMID: 33994294 DOI: 10.1016/j.jcms.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
This randomized controlled clinical trial aimed to evaluate the preemptive effects of acetaminophen, ibuprofen, ketoprofen, nimesulide or dexamethasone on postoperative pain and edema in the surgical removal of impacted third molars. Participants underwent bilateral surgeries at 2 different times and were randomly given the test drug or placebo (split-mouth). Postoperative pain, edema and rescue medication were evaluated at different times. Study power was >80% for the observed effect size in the crossover repeated measures design. Differences between test drug and placebo were the response variable. Generalized Estimation Equation models were adjusted for each outcome. Sample comprised 5 groups (n = 20 each). Ibuprofen and nimesulide showed higher overall effects on pain scores over time, with no differences between them (p = 0.557). Acetaminophen showed significantly lower overall effects in edema control over time, when compared to other test drugs, that showed similar effects. Lower quantity of rescue medication were also observed for ibuprofen and nimesulide, with no differences between them (p = 0.999). Ibuprofen and nimesulide showed beneficial overall preemptive effects. Hence, in the decision-making process for preemptive analgesia in impacted third molar surgeries, ibuprofen and nimesulide should be considered on a case-by-case basis as the drugs of choice.
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Affiliation(s)
- Bianca Fernanda Espósito Santos
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Renata Magalhães Cyrino
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís Otávio Miranda Cota
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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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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Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials. J Craniomaxillofac Surg 2020; 48:293-307. [DOI: 10.1016/j.jcms.2020.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/23/2019] [Accepted: 01/25/2020] [Indexed: 02/06/2023] Open
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Pereira GM, Cota LOM, Lima RPE, Costa FO. Effect of preemptive analgesia with ibuprofen in the control of postoperative pain in dental implant surgeries: A randomized, triple-blind controlled clinical trial. J Clin Exp Dent 2020; 12:e71-e78. [PMID: 31976047 PMCID: PMC6969969 DOI: 10.4317/medoral.56171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Preemptive analgesia has as its basic principle the administration of analgesics before the onset of painful stimuli, in order to reduce or prevent postoperative pain, but this question is little explored in implantology. Thus, this study was conducted in order to evaluate the clinical efficacy of ibuprofen in pain prevention after unit implant surgery. MATERIAL AND METHODS For this triple-blind, parallel, placebo-controlled and randomized clinical trial, 54 insertion surgeries of unitary implants were performed. Two groups have received two different protocols 1 hour before surgery: Ibuprofen group (IBU) 600 mg of ibuprofen; and (2) placebo group (maize starch). The intensity of the pain was evaluated through the visual analogue scale (VAS) in 6 times (1, 6, 12, 24, 48 and 72 hours after the surgery). Patients were instructed to take 750 mg of paracetamol as rescue medication, if necessary. The occurrence and the intensity of pain were analyzed by means of an analysis of variance ANOVA with repeated measurements using the general linear model procedure. RESULTS The IBU group had significantly lower VAS scores overall (IBU = 0.30, ± 0.57; placebo = 1.14, ± 1.07; p<0.001) and at all times in the intra, intergroup comparisons and time/group interaction than the placebo group (p<0.001). The use of rescue medication was significantly lower and the postoperative time was longer in the IBU group compared to placebo (p = 0.002). CONCLUSIONS The single use of ibuprofen was found to be significantly superior in reducing pain after unit implant surgery compared to placebo. Key words:Analgesia, dental implants, pain, surgery, oral.
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Affiliation(s)
- Gustavo-Mattos Pereira
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís-Otávio-Miranda Cota
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael-Paschoal-Esteves Lima
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando-Oliveira Costa
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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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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Gümrükçü Z. The effects of piezosurgery and submucosal dexamethasone injection on post-operative complications after third molar surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:182-187. [PMID: 30396027 DOI: 10.1016/j.jormas.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A retrospective clinical study was performed to compare the post-operative effects of the conventional surgery, piezo surgery technique and submucosal dexamethasone injection in lower third molars extractions. METHODS Data from 62 patients, subjected to surgical extraction of lower third molars, were pooled and divided into three groups such as: Conventional Group (22 patients), Piezo Group (20 patients) and Dex Group (conventional surgery + 4 mg/1 mL dexamethasone) (20 patients). Pain, swelling, trismus, analgesic consumption and operation time were comparatively evaluated. RESULTS Pain values were found lower in Dex Group in comparison to Conventional Group at 7th day (P = 0.007). Edema found to be higher in Conventional Group than Dex Group at 2nd day (P = 0.025). Minimally trismus values were found in Dex Group and the difference between the Dex and Conventional Group found to be statistically significant both in 2nd (P = 0.048) and 7th days (P = 0.010). The analgesic consumption in the Conventional Group was found to be higher than Piezo Group at 2nd day (P = 0.002). CONCLUSION The better post-operative values were obtained in the Dex Group. Although longer operative time is considered to be a disadvantage for the piezo technique, piezotome may be preferred for surgical procedures due to its positive results in comparison to the conventional technique.
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Affiliation(s)
- Z Gümrükçü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey.
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Falci SGM, Lima TC, Martins CC, Santos CRRD, Pinheiro MLP. Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis. Anesth Prog 2018; 64:136-143. [PMID: 28858550 DOI: 10.2344/anpr-64-05-08] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti-inflammatories. An electronic search was conducted for preemptive effects related to lower third-molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta-analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split-mouth clinical trials were selected. Two studies were included in the meta-analysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti-inflammatories for preemptive effectiveness. Meta-analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = -1.28 to -0.38), 4 days (95% CI = -1.65 to -0.71), 7 days (95% CI = -1.42 to -0.71), and overall (95% CI = -1.25 to -0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI = 0.18 to 1.07). There is insufficient evidence through meta-analysis to conclude that dexamethasone is better than other nonsteroidal anti-inflammatories or methylprednisolone as a preemptive analgesic. The results of this meta-analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery Professor, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Thiago César Lima
- Master Student, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Carolina Castro Martins
- Pediatric Dentistry Professor, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cássio Roberto Rocha Dos Santos
- Oral and Maxillofacial Surgery Professor, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Marcos Luciano Pimenta Pinheiro
- Pharmacology and Therapeutic Professor, Department of Basic Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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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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Lima TC, Bagordakis E, Falci SGM, dos Santos CRR, Pinheiro MLP. Pre-Emptive Effect of Dexamethasone and Diclofenac Sodium Associated With Codeine on Pain, Swelling, and Trismus After Third Molar Surgery: A Split-Mouth, Randomized, Triple-Blind, Controlled Clinical Trial. J Oral Maxillofac Surg 2018; 76:60-66. [DOI: 10.1016/j.joms.2017.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 11/25/2022]
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Lima CAA, Favarini VT, Torres AM, da Silva RA, Sato FRL. Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial. Oral Maxillofac Surg 2017; 21:321-326. [PMID: 28597117 DOI: 10.1007/s10006-017-0635-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The aim of this study was to compare the anti-inflammatory potential of two pharmacotherapy protocols based on the parameters of pain, trismus, and swelling, after extraction of third molars. METHODS Thirty patients selected with symmetrical impaction of third molars were submitted to surgical procedures in both sides in different times. For one group, dexamethasone was used for 3 days, and for another group diclofenac sodium was also used for the same period. The main variables analyzed were the visual analogue pain scale (VAS), but others were also analyzed such as swelling and trismus, which were submitted to statistical analysis. RESULTS The results had no difference regarding the length of procedures (p = 0.986) and the pain in the immediate and 4-h postoperative period (p = 0.723 and 0.541). The rescue analgesic consumption was higher (p < 0.05) when using the protocol with diclofenac sodium. The variables mouth opening (p < 0.05) and swelling (p < 0.05) were significantly better when using the protocol with dexamethasone in the postoperative period. CONCLUSIONS Medical protocol with the use of dexamethasone in the postoperative period was more effective in controlling pain, trismus, and swelling, after the extraction of third molars, when compared to diclofenac sodium.
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Affiliation(s)
| | | | | | | | - Fábio Ricardo Loureiro Sato
- Oral and Maxillofacial Surgery Area, State University of São Paulo-UNESP, College of Dentistry, São José dos Campos and Oral and Maxillofacial Surgeon, Hospital Geral de Vila Penteado, Av. Eng. Francisco José Longo, 777-12245-000, São José dos Campos, São Paulo, SP, Brazil.
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Submucosal injection of dexamethasone reduces postoperative discomfort after third-molar extraction. J Am Dent Assoc 2017; 148:81-91. [DOI: 10.1016/j.adaj.2016.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022]
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Calvo AM, Prado MTDO, Dionísio TJ, Marques MP, Brozoski DT, Lanchote VL, Faria FAC, Santos CF. Effective method for the detection of piroxicam in human plasma using HPLC. Braz Oral Res 2016; 30:S1806-83242016000100253. [PMID: 27223141 DOI: 10.1590/1807-3107bor-2016.vol30.0058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/10/2016] [Indexed: 11/22/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used by the general population to alleviate inflammation and pain after oral surgeries. Piroxicam is among the most commonly used NSAIDs and excels in controlling pain, swelling, trismus and other common symptoms of inflammation. This study aimed to evaluate different concentrations of piroxicam and its major metabolite, 5'-hydroxypiroxicam, in human plasma samples over time using high performance liquid chromatography (HPLC) after liquid-liquid extraction. Briefly, 10 volunteers participated in this study after approval by the Ethics Committee of Bauru School of Dentistry, Universidade de São Paulo - USP, Brazil. Volunteers received a single dose oral of piroxicam (20 mg) and had blood collected at various times following an established protocol. The methodology of liquid-liquid extraction was effective for determining concentrations of piroxicam in plasma using HPLC in 10 out of 10 volunteers while 5'-hydroxypiroxicam was only detected in 2 out of 10 volunteers.
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Affiliation(s)
- Adriana Maria Calvo
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
| | | | - Thiago José Dionísio
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
| | - Maria Paula Marques
- Universidade de São Paulo - USP, School of Pharmaceutical Sciences of Ribeirão Preto, Laboratory Specialist, Department of Clinical, Toxicologic and Bromatologic Analyses, Ribeirão Preto, SP, Brazil
| | - Daniel Thomas Brozoski
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
| | - Vera Lúcia Lanchote
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
| | - Flávio Augusto Cardoso Faria
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
| | - Carlos Ferreira Santos
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
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Costa FLDS, Tiussi LD, Nascimento MS, Corrêa ACDS, Yasojima EY, Pires CAA. Diclofenac topical gel in excisional wounds maintain heal quality and reduce phlogistic signals1. Acta Cir Bras 2014; 29:328-33. [DOI: 10.1590/s0102-86502014000500007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/19/2014] [Indexed: 11/22/2022] Open
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