Balanced pre-emptive analgesia: does it work? A double-blind, controlled study in bilaterally symmetrical oral surgery

Abstract

We studied 32 patients undergoing bilateral symmetrical lower third molar surgery under general anaesthesia to determine if the combined effects of pre-emptive local anaesthetic block using 0.5% bupivacaine, together with i.v. tenoxicam and alfentanil had any benefits over postoperative administration. Patients acted as their own controls and were allocated randomly to have surgery start on one side, the second side always being the pre-emptive side. Difference in pain intensity between the two sides was determined using visual analogue scales completed by each individual at 6 h, and at 1, 3 and 6 days after operation. A long-form McGill pain questionnaire was also used to assess difference in pain intensity between the two sides on the morning after surgery. There was no significant difference in pain intensity at any time after surgery. Our findings indicate that the combined use of pre-emptive analgesia from 0.5% bupivacaine, tenoxicam and alfentanil did not reduce postoperative pain intensity in patients undergoing molar exodontia.

Premedication with cyclooxygenase-2 inhibitor meloxicam reduced postoperative pain in patients after oral surgery

“…The degree of difficulty of the procedure was evaluated using the following 4-grade scale presented by CAMPBELL et al 4 : (i) simple tooth extraction, (ii) bone removal or tooth division, (iii) bone removal and tooth division and (iv) the same as (iii) but very difficult. After surgery, the patients were discharged from the hospital with a prescription of loxoprofen tablets, 60 mg per tablet, for postoperative pain relief.…”

“…The pathophysiological mechanisms of such neuropathic pain have been elucidated 8,20 and a number of interventions have been attempted to prevent or reduce postoperative pain 2,4,13,14,23,24 . Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the examples 2,4,13,14,23,24 , but are still controversial 2,3,13,14 .…”

Changes in sensory processing after surgical nociception

“…A number of editorials and reviews of this topic published at the time suggested the need for improved study designs in order to obtain more convincing results [18][19][20][21]. Many preemptive analgesia studies have been carried out since that time, incorporating the design improvements suggested (eg, effect proven [22][23][24][25][26][27][28][29][30][31]; no effect proven [32][33][34][35][36][37]). Although this has resulted in more success in proving an effect of preemptive analgesia for certain substances (notably opioids, local anesthetics, and NMDA-receptor antagonists), the effects demonstrated have remained clinically modest and of short duration.…”

Analgesic efficacy of celecoxib in patients after oral surgery: special reference to time to onset of analgesia and duration of analgesic effect

“…The same extraction technique was employed for all patients. The degree of difficulty of the procedure was evaluated using the following four-grade scale presented by Campbell et al [13]; (i) simple tooth extraction, (ii) bone removal or tooth division, (iii) bone removal and tooth division, and (iv) the same as (iii) but very difficult.…”