An investigation into the comparative efficacy of soluble aspirin and solid paracetamol in postoperative pain after third molar surgery

Abstract

Objective To compare the efficacy of soluble aspirin 900 mg and paracetamol 1,000 mg in patients with postoperative pain after third molar surgery. Design A randomised, placebo controlled, double-blind study. Setting Day stay units of Oral and Maxillofacial Surgery at Cardiff Dental Hospital and Hexham General Hospital, Northumberland. Subjects and methods One hundred and sixty-seven (104 female) patients who required the removal of their impacted third molars under general anaesthesia. Intervention In the early postoperative period, patients were medicated with either a single dose of soluble aspirin 900 mg, solid paracetamol 1,000 mg or placebo. Main outcome measures Pain intensity was measured on 100 mm visual analogue scales at 0,5,10, 15, 20, 30, 45, 60, 90, 120 and 240 minutes after dosing. Other efficacy variables evaluated included time to rescue medication and an overall assessment of the study medication efficacy by the patient on completion of the study. Results One hundred and sixty-seven patients consented to take part in the study, but only 153 were medicated. Of the 14 patients not treated, 10 failed to develop sufficient pain to enter the study, two withdrew consent, one had an adverse reaction to the general anaesthetic and one was a protocol violator. Over the four hour investigation period, patients treated with soluble aspirin reported significantly less pain when compared with those treated with paracetamol (mean difference in AUC 0-240 = -2001, 95% CI -3893 to -109, p=0.038) and placebo (mean difference in AUC 0-240 = -3470, 95% CI -5719 to -1221, p=0.003).

Colon perforation with acute peritonitis after taking clindamycin and diclofenac following wisdom tooth removal

“…This concur with the fact that paracetamol has a weak anti-inflammatory effect and no influence on thrombocytes (Brune et al, 2000;Stichtenoth and Froehlich, 2001). Nevertheless, controlled prospective clinical studies have shown that when compared with NSAIDs, therapeutically adequate concentrations of paracetamol administered after surgery also have a sufficiently high analgesic effect (Mattews et al, 1984;Coulthard et al, 2001;Hyllested et al, 2002;Bjørnsson et al, 2003;Seymour et al, 2003). Thus, ibuprofen (4 Â 600 mg/d/orally) administered after surgical removal of wisdom teeth showed no clinical advantage over paracetamol (4 Â 1000 mg/d/orally) with regard to reducing postoperative swelling and pain (Bjørnsson et al, 2003).…”

“…Erosions, ulceration and gastrointestinal perforations have in the meantime been described for all drugs with preferential COX-2 inhibition (Brune et al, 2000). COX-2 inhibitors are also being used in dental pain therapy, and clinical studies have proved their suitability, but a clear superiority of COX-2 inhibitors in postoperative dental pain therapy has not yet been shown (Bakshi et al, 1994;Malmstrom et al, 1999;Seymour et al, 2000;Chang et al, 2002;Hyllested et al, 2002;Jeske, 2002;Seymour et al, 2003). In contrast to NSAIDs, the aniline derivative paracetamol has only a weak effect on COX-1 and none on COX-2.…”

Effectiveness of green tea mouthwash in postoperative pain control following surgical removal of impacted third molars: double blind randomized clinical trial

“…To relief this pain, various protocols have been proposed; none of which was based on herbal medicine [1,7-13,21-29]. …”

“…Various medications have been used to control postoperative pain following surgical removal of impacted molar teeth [1,7-13]. Analgesics including paracetamole and diclofenac sodium in addition to non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used to control postoperative pain.…”

Research in primary dental care Part 2: Developing a research question

“…An example of this type of study is provided by Seymour et al who investigated the comparative efficacy of aspirin and paracetamol in relieving postoperative pain after third molar surgery. 8 …”