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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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Karpe T, Sanober A, Nasyam FA, Soumya S, Seethamsetty S, Sarepally G. To Study the Impact of Tooth Sectioning on Postoperative Pain, Swelling and Trismus After Surgical Extraction of Impacted Mandibular Third Molars. Cureus 2023; 15:e51207. [PMID: 38283454 PMCID: PMC10818164 DOI: 10.7759/cureus.51207] [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] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
AIM To study the impact of tooth sectioning on postoperative pain, swelling, and trismus after surgical extraction of impacted mandibular third molars. MATERIALS AND METHODS The present research was conducted on a sample of 100 individuals who were in good health. The participants had an average age of 28 years and were seeking treatment at the Department of Oral and Maxillofacial Surgery for the extraction of impacted mandibular third molars. The participants were allocated randomly to one of the two experimental conditions. The patients in Group A are receiving a surgical procedure to remove the mandibular third molar without the need for tooth sectioning. The study focuses on patients classified as Group B who are having a surgical procedure for the extraction of the mandibular third molar using dental sectioning. RESULTS The Group B patients saw a notable decrease in pain intensity on the third and seventh days after the surgery. The mean difference in pain scores was 4.15±0.54 and 1.69±0.11, respectively, indicating statistically significant findings with a p-value of less than 0.05. The study observed statistically significant differences in swelling between the 1st, 3rd, and 7th postoperative days for group II. The mean differences were recorded as 149.85±5.86, 119.25±4.22, and 107.52±, respectively. The significance level was determined to be P<0.05. The study observed that the degree of mouth opening in Group B exhibited a significant rise on the 3rd and 7th postoperative days, with a mean difference of 40.87±3.69 and 43.15±3.29, respectively, as compared to Group A. This difference was found to be statistically significant, with a p-value of less than 0.05. Conclusion: The findings of our research indicate that the technique of sectioning the tooth is the preferable approach for surgical extraction of impacted third molars, as it effectively reduces the occurrence of post-operative problems.
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Affiliation(s)
- Tanveer Karpe
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, Faculty of Dentistry, Taif University, Taif, SAU
| | - Arshiya Sanober
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hyderabad, IND
| | - Fazil A Nasyam
- Department of Oral and Maxillofacial Surgery and Diagnostics Sciences, College of Dentistry, Prince Sattam Bin Abdul Aziz University, Al Karj, SAU
| | - Sureddy Soumya
- Department of Oral and Maxillofacial Surgery, Swetha Reddy Multi Speciality Dental Clinic, Hyderabad, IND
| | - Swetcha Seethamsetty
- Department of Oral and Maxillofacial Surgery, Leela Dental Specialities, Kakinada, IND
| | - Godvine Sarepally
- Department of Oral and Maxillofacial Surgery, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, IND
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Dallazen E, Baccaro GC, Santos AMDS, Queiroz ME, Santiago Junior JF, Hochuli-Vieira E, Faverani L. Comparison of Manual (2D) and Digital (3D) Methods in the Assessment of Simulated Facial Edema. J Oral Maxillofac Surg 2023; 81:1146-1154. [PMID: 37308089 DOI: 10.1016/j.joms.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND An edema assessment following dental surgeries is essential to improving the dental surgeon's technique and, consequentially, patient comfort. PURPOSE Two-dimensional (2D) methods are limited in analyzing 3-dimensional (3D) surfaces. Currently, 3D methods are used to investigate postoperative swelling. However, there are no studies that directly compare 2D and 3D methods. The goal of this study is to directly compare 2D and 3D methods used in the assessment of postoperative edema. STUDY DESIGN AND SAMPLE The investigators implemented a prospective, cross-sectional study with each subject serving as its own control. The sample was composed of dental student volunteers without facial deformities. PREDICTOR VARIABLE The predictor variable is the method used to measure edema. After simulating edema, manual (2D) and digital (3D) techniques were used to measure edema. The manual method used direct facial perimeter measurements. The two digital methods were photogrammetry using a smartphone (iPhone 11, Apple Inc, Cupertino, California), and facial scanning with a smartphone application (Bellus3D FaceApp, Bellus3D Inc, Campbell, California) [3D measurements] MAIN OUTCOME VARIABLE: The coefficient of variation (CV) (CV = standard deviation /mean) was used to assess homogeneity of edema measurements. ANALYSIS The Shapiro-Wilk and equal variance tests were applied to assess data homogeneity. Next, one-way analysis of variance was performed, followed by a correlation analysis. Finally, the data were submitted to Tukey's test. The statistical significance threshold was set at 5% (P < .05). RESULTS The sample was composed of 20 subjects aged 18-38 years. The CV showed higher values using the manual (2D) method (47%; 4.88% ± 2.99), compared with the photogrammetry method (18%; 8.55 mm ± 1.52) and the smartphone application (21%; 8.97 mm ± 1.93). A statistically significant difference was observed between the manual method values and those of the other two groups (P < .001). There was no difference between the facial scanning and photogrammetry groups (3D methods) (P = .778) CONCLUSION AND RELEVANCE: Both digital measuring methods (3D) demonstrated greater homogeneity than the manual method in analyzing facial distortions caused by the same swelling simulation. Therefore, it can be affirmed that digital methods may be more reliable that manual methods for assessing facial edema.
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Affiliation(s)
- Eduardo Dallazen
- PhD Student, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Gabriela Cristina Baccaro
- DDS Student, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Anderson Maikon de Souza Santos
- PhD Student, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Assistant Professor, Division of Oral Surgery, Paraíba State University, Araruna, Brazil
| | - Mariana Elias Queiroz
- PhD Student, Department of Dental Materials and Prosthesis, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Eduardo Hochuli-Vieira
- Associate Professor, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo, Brazil
| | - Leonardo Faverani
- Associate Professor, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil.
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Silva PUJ, Meneses-Santos D, Vieira WDA, Ramacciato JC, da Silva RP, da Silva MCP, Rode SDM, Paranhos LR. Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials. Clinics (Sao Paulo) 2021; 76:e2780. [PMID: 34190850 PMCID: PMC8221561 DOI: 10.6061/clinics/2021/e2780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including "grey literature." The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The "Joanna Briggs Institute for Randomized Controlled Trials" tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure.
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Affiliation(s)
- Pedro Urquiza Jayme Silva
- Program de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Daniela Meneses-Santos
- Programa de Residencia, Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Walbert de Andrade Vieira
- Departamento de Odontologia Restauradora, Divisao de Endodontia, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP, BR
| | - Juliana Cama Ramacciato
- Departamento de Farmacologia, Anestesiologia e Terapeutica, Faculdade de Medicina e Odontologia e Centro de Pesquisas Odontologicas Sao Leopoldo Mandic, Campinas, SP, BR
| | - Ricardo Pedro da Silva
- Program de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Marcelo Caetano Parreira da Silva
- Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Odontologia, Universidade Federal de Uberlandia (UFU), Uberlandia, MG, BR
| | - Sigmar de Mello Rode
- Departamento de Materiais Odontologicos e Protese, Instituto de Ciencia e Tecnologia, Universidade Estadual Paulista Julio de Mesquita Filho, Campus Sao Jose dos Campos, Sao Jose dos Campos, SP, BR
| | - Luiz Renato Paranhos
- Area de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal de Uberlandia (UFU), Uberlandia, MG, BR
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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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Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study. J Oral Maxillofac Surg 2019; 77:1990-1997. [DOI: 10.1016/j.joms.2019.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
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Küpeli İ, Gülnahar Y. Impact of Pre-Emptive Intravenous Ibuprofen on Perioperative Analgesia in Patients Undergoing Third Molar Extraction: A Randomised Controlled Study. Turk J Anaesthesiol Reanim 2019; 47:480-484. [PMID: 31828245 DOI: 10.5152/tjar.2019.09623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/12/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the present study was to evaluate the analgesic efficacy of pre-emptive intravenous (iv) ibuprofen on pain during and after the mandibular third molar surgery. Methods A total of 60 patients were included in the study. They were allocated as ibuprofen 800 mg iv+dexketoprofen 50 mg (group 1), ibuprofen 800 mg iv alone (group 2) or placebo (group 3). A local anaesthetic infiltration was administered to all patients. In all patients, haemodynamic values (mean arterial pressure (MAP) and heart rate (HR)) were recorded preoperatively, and infusions were started. State-Trait Anxiety Inventory (STAI) scale was used to assess anxiety states. Surgery started 15 min after the infusion. Haemodynamic values and pain scores with visual analogue scale (VAS) were recorded. Pain scores were recorded postoperatively at rest (VASR) and swallowing (VASS). Results There was no significant difference in the preoperative STAI values between the groups (p>0.05). HR, MAP and VAS pain scores were significantly higher in group 3 than in groups 1 and 2 (p<0.05). VASR and VASS scores were significantly higher in group 3 than in group 1 in the first 4 h postoperatively (p<0.05). VASS scores were significantly higher in group 3 than in group 2 at 1-4 h postoperatively (p<0.05), but there was no difference in VASR and VASS scores at 48 h after surgery. Conclusion Ibuprofen alone or in combination with dexketoprofen provided similar analgesia in the perioperative period when administered pre-emptively.
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Affiliation(s)
- İlke Küpeli
- Department of Anaesthesiology and Reanimation, Erzincan Binali Yıldırım University School of Medicine, Erzincan, Turkey
| | - Yakup Gülnahar
- Department of Oral and Maxillofacial Surgery, Erzincan Binali Yıldırım University School of Medicine, Erzincan, Turkey
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Local Ketamine Improves Postoperative Analgesia After Third Molar Surgery. J Oral Maxillofac Surg 2019; 77:2386-2400. [PMID: 31404519 DOI: 10.1016/j.joms.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/06/2019] [Accepted: 07/06/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Evidence exists to support the peripheral analgesic effect of local administration of ketamine (LAK) after third molar surgery. The aim of the present systematic review and meta-analysis was to determine the efficacy of LAK in the control of pain, swelling, and trismus after third molar surgery. MATERIALS AND METHODS The study design was a systematic review with a meta-analysis of the effect of LAK after third molar surgery. A search in electronic databases was performed from September 2017 to February 2019. Only prospective clinical trials and randomized controlled trials that had evaluated LAK after third molar surgery were included. The meta-analysis was based on the random effects model. The outcome measures evaluated were postoperative acute pain, swelling, and trismus. The estimated overall effect size was a standardized mean difference (SMD). RESULTS A total of 110 study subjects (men and women aged 18 to 50 years) were evaluated for the analgesic effect. The SMD showed a significant analgesic effect (postoperative pain control) favoring LAK (SMD, -1.7403; 95% confidence interval [CI], -2.45 to -1.04). Evaluation of the anti-inflammatory effect of LAK included 105 study subjects and resulted in significantly less swelling in the first postoperative day (SMD, -0.6169; 95% CI, -1.1654 to -0.0683). However, LAK did not reduce the incidence of trismus after third molar surgery (SMD, -0.7241; 95% CI, -2.2765 to 0.8284). CONCLUSIONS The use of LAK can reduce the incidence and severity of postoperative pain after third molar surgery and had an anti-inflammatory effect, although only in the first postoperative day. However, LAK had no effect on trismus reduction after third molar surgery.
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