Pre-Emptive Analgesic Effect of Tramadol After Mandibular Third Molar Extraction: A Pilot Study

Pre-emptive analgesia aims at preventing the central nervous system from reaching a hyper-excitable state known as central sensitization, in which it responds excessively to afferent inputs. The clinical implication would be more effective pain management, thereby reducing post-operative pain and analgesic requirements. This study aimed at investigating the existence of preemptive analgesia and to compare the pre-emptive analgesic efficacy of im ketorolac [NSAID] versus tramadol [SYNTHETIC OPIOD] for post-operative pain management following third molar surgery. Fifty patients under the age group of 16-25 years with asymptomatic, symmetrically impacted mandibular third molars were equally divided into 2 groups and underwent third molar surgery under local anesthesia. Ketorolac 30 mg and tramadol 50 mg were used in the study group, while sodium chloride 0.9 % was used in the control group. Study parameters included pain intensity scores for 12 post-operative hours, time to 1st rescue analgesia, total number of analgesics consumed during the 5 post-operative days and patients' self assessment of efficacy of the surgery with regardsto no pain. Statistically, the data are presented as the mean values with their standard deviations and a 95 % confidence interval [p is significant, if p \ 0.05] for the mean are applicable. Incidences of adverse events like pain on injection of the study drug, local reactions, nausea and vomiting were noted. Patients in the study group significantly performed better than the control group in terms of all the parameters; while among the study group, ketorolac fared better than tramadol. All the drug related complications were mild and did not require any intervention. Preoperative ketorolac or tramadol in comparison to placebo resulted in a significantly better post-operative pain management. However as against tramadol, ketorolac is a better choice as a pre-emptive analgesic agent for the post-operative pain management following third molar surgery.

Section: Discussionmentioning

confidence: 95%

Section: Follow Up Designmentioning

confidence: 99%

Comparative Evaluation of Pre-Emptive Analgesic Efficacy of Intramuscular Ketorolac Versus Tramadol Following Third Molar Surgery

Shah¹,

Kumar

2012

“…Vegas-Bustamante et al [15] showed that local injection of a single 40-mg dose of methylprednisolone into the masseter muscle on completion of the extraction of impacted lower third molars decreased swelling, trismus, and pain. Guillen et al [16] compared the efficacy of tramadol given before or immediately after surgical extraction of an impacted mandibular third molar under local anesthesia. The analgesic efficacy measured as complete relief of pain at 24 h was 86 % in the preemptive tramadol compared with 70 and 36 % for postoperative tramadol administration and control group.…”

Section: Discussionmentioning

confidence: 99%

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

Purpose In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Methods Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision. Results The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p \ .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p [ .05) on the 1st, 3rd and 7th post-operative days. Conclusion The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.

“…Impaction of third molar teeth is a common disorder which often necessitates their removal [6]. Surgical removal of an impacted third molar is a model used commonly to test the efficacy of analgesics for acute dental pain [4].…”

Section: Discussionmentioning

confidence: 99%

“…Patients typically associate dental care with pain and an experience of poorly managed pain related to dental treatment can lead patients to avoid or postpone treatment, as well as make them more difficult to treat [4].…”

Section: Discussionmentioning

confidence: 99%

A comparitive study of diclofenac transdermal patch against oral diclofenac for pain control following removal of mandibular impacted third molars

Bachalli

Nandakumar

Srinath

2009

Objective The objectives of this study was to evaluate subjectively the analgesic efficacy of Oral Diclofenac Sodium against Diclofenac Sodium Transdermal patch in the management of postoperative pain following surgical removal of impacted mandibular third molars. Materials and methods Twenty healthy subjects belonging to both the sexes in the age group of 18-40 years with bilateral mesioangular impactions of mandibular third molar teeth underwent surgical removal under local anaesthesia by administering an inferior alveolar nerve block on two different occasions with a minimum interval of 1 week in-between the procedures. The postoperative pain was recorded on visual analog scale, a verbal rating scale, a pain relief scale and a pain intensity scale. Readings were taken at 2 hours, 4 hours, 8 hours, 12 hours and 24 hours postoperatively, taking the time at which the surgery was completed as a reference. On the second and third days, the repeat medication was administered at that reference time and recordings taken at the same intervals for a total of 3 days. Patients received the study medication i.e. Diclofenac Sodium 100mg once a day for 3 days after performing surgery on one side and the same patients were given Diclofenac Sodium Transdermal Patch 100mg once a day for 3 days after performing surgery on the contralateral side. Results and observations Both the statistical analysis and clinical observation showed that on the first postoperative day diclofenac sodium administered orally has slightly more significant efficacy when compared to the drug administered transdermally. However, on the second and third postoperative days there was no statistical or clinical difference in the pain control by either route of administration. Conclusions The study concludes that transdermal diclofenac sodium can be used as an alternative form of pain control following removal of impacted mandibular third molars, however considering that the analgesic potency might be lesser in the immediate postoperative period, it might be prudent to use oral diclofenac sodium for immediate postoperative pain relief, following which transdermal route can be used for pain control.