A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120mg on inflammatory events following removal of unerupted mandibular third molars

Abstract

Pain after third molar extraction has been considered the most suitable pharmaceutical model to evaluate acute pain. This study aimed to evaluate the pre-emptive analgesic/anti-inflammatory efficacy of etoricoxib 120 mg following mandibular third molar surgery. A split-mouth, randomized, triple-blind, placebo-controlled study was conducted with patients undergoing the surgical removal of mandibular third molars. All volunteers were allocated randomly to receive either etoricoxib 120 mg or placebo 1h preoperatively, and inflammatory events were evaluated. An estimated sample of 18 surgical units per group was required based on a pilot study (95% confidence level and 80% statistical power). Rescue medication was analyzed by Kaplan-Meier method through log-rank Mantel-Cox test and Pearson linear correlation (P<0.05). Pre-emptive etoricoxib reduced postoperative pain scores significantly in comparison to placebo (P<0.001), with a pain score peak at 6h after surgery (P<0.001). The mean rescue medication consumption was lower in the etoricoxib group compared to the placebo group over the study period (P<0.05). There was no statistically significant difference between groups related to swelling and trismus. The pre-emptive administration of etoricoxib 120 mg significantly reduced the postoperative pain intensity and the need for rescue medication, but did not reduce swelling or trismus.

Evaluation of low-level laser at auriculotherapy points to reduce postoperative pain in inferior third molar surgery: study protocol for a randomized controlled trial

“…The main rationale for conducting this study is for the reduction of postoperative anti-inflammatory drug and analgesic use because of the frequency of adverse effects associated with their use [8, 9]. Extraction of third molars is considered the best model for assessing acute pain [32] and has been used for a long time [33]. To avoid bias, the two surgeries (experimental side and control side) should be performed as closely as possible; however, a time interval between surgeries is necessary to avoid distortions in patient’s judgement of their pain [34].…”

RT-qPCR study of COX-1 and -2 genes in oral surgical model comparing single-dose preemptive ibuprofen and etoricoxib: A randomized clinical trialy

“…This connection is not observed in association with the constitutively expressed COX-1. COX inhibition provided by NSAIDs confers relief of pain and inflammation that follows oral surgery procedures, justifying clinical interest on COX isoforms (3). Third molar surgeries are highly invasive procedures capable of triggering various levels of inflammatory pain that may potentially impact the quality of life of patients with short and medium-term repercussions; hence, these procedures have been historically established models to study the efficacy of various centrally and non-centrally acting analgesics and anti-inflammatory drugs (4)(5)(6).…”

“…A previous study demonstrated a distinct synthesis of COX-1 metabolites and PGE2 production mediated by COX-1 and -2 following oral surgery procedures, in the absence of rescue medications (7). Preemptive analgesia aims to prevent or diminish postoperative pain and inflammation, reducing the need for medication in the days immediately following surgery (3,8).…”

Pharmacological Control of Complications Following to Third Molar Removal: Evidence Based on A Meta-Analysis

“…Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are the two kind of drugs mainly used to control these postsurgical signs and symptoms [2]. NSAIDs are the most used drugs to treat the complications after mandibular third molar surgical extraction showing different grades of clinical effectiveness [3]. Moreover, the corticosteroids are used with the same purpose [4,5].…”