Preoperative Intravenous Tramadol Versus Diclofenac for Preventing Postoperative Pain After Third Molar Surgery: A Comparative Study

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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“…Preferential cyclo oxygenase -2 inhibitors Diclofenac [15,17,18,27,36,37], Meloxicam [42], Nimesulide [40]. 7.…”

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confidence: 99%

Pre-emptive analgesic efficacy of injected ketorolac in comparison to other agents for third molar surgical removal: a systematic review

Tirupathi

Rajasekhar²,

Maloth

et al. 2021

J Dent Anesth Pain Med

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“…Preemptive analgesia may decrease post-operative pain in the clinic. In previous clinical studies, preemptive administration of an analgesic agent has been shown to improve postoperative pain control in case of laparoscopic radical prostatectomy [ 28 ], thoracotomy [ 29 ], and third molar extraction [ 30 31 ]. Additionally, preemptive application of 1% lidocaine for 10 minutes prior to L4 and L5 bilateral dorsal rhizotomy significantly attenuates hindlimb mechanical allodynia in patients with failed back surgery syndrome [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Preemptive application of QX-314 attenuates trigeminal neuropathic mechanical allodynia in rats

Yoon

Son

Kim

et al. 2018

Korean J Physiol Pharmacol

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The aim of the present study was to examine the effects of preemptive analgesia on the development of trigeminal neuropathic pain. For this purpose, mechanical allodynia was evaluated in male Sprague-Dawley rats using chronic constriction injury of the infraorbital nerve (CCI-ION) and perineural application of 2% QX-314 to the infraorbital nerve. CCI-ION produced severe mechanical allodynia, which was maintained until postoperative day (POD) 30. An immediate single application of 2% QX-314 to the infraorbital nerve following CCI-ION significantly reduced neuropathic mechanical allodynia. Immediate double application of QX-314 produced a greater attenuation of mechanical allodynia than a single application of QX-314. Immediate double application of 2% QX-314 reduced the CCI-ION-induced upregulation of GFAP and p-p38 expression in the trigeminal ganglion. The upregulated p-p38 expression was co-localized with NeuN, a neuronal cell marker. We also investigated the role of voltage-gated sodium channels (Navs) in the antinociception produced by preemptive application of QX-314 through analysis of the changes in Nav expression in the trigeminal ganglion following CCI-ION. Preemptive application of QX-314 significantly reduced the upregulation of Nav1.3, 1.7, and 1.9 produced by CCI-ION. These results suggest that long-lasting blockade of the transmission of pain signaling inhibits the development of neuropathic pain through the regulation of Nav isoform expression in the trigeminal ganglion. Importantly, these results provide a potential preemptive therapeutic strategy for the treatment of neuropathic pain after nerve injury.

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“…Oncul et al compared preoperative IV diclofenac sodium with IV paracetamol (acetaminophen) and Lornoxicam and concluded that although all were equally effective on postoperative pain ( 16 ). Diclofenac was reported to be better in controlling postoperative pain compared to tramadol and ketorolac but less compared to piroxicam and nimesulid and tenoxicam ( 17 - 21 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effect of Naproxen, Etodolac and Diclofenac on postoperative sequelsfollowing third molar surgery: A randomised, double-blind, crossover study

Akbulut¹,

Üstüner²,

Atakan³

et al. 2014

Med Oral

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Objectives: To compare the three non-steroidal anti-inflammatory agents (NSAIDs) diclofenac potassium, etodolac and naproxen sodium in relation to pain, swelling and trismus following impacted third molar surgery. Study Design: The study was a randomized and a double-blinded study which included 42 healthy young individuals with impacted third molars and bone retention. Patients were randomly assigned to 3 groups (n: 14) to which diclofenac potassium, naproxen sodium and etodolac were administered orally an hour before the operation. Impacted third molars were surgically extracted with local anaesthesia. Visual analog scales (VAS) were used to assess the pain in the 6th, 12th hours and on the 1st, 2nd, 3rd, 5th, and 7th days postoperatively. Swelling was evaluated using ultrasound (US) and mouth opening (trismus) was measured with a composing stick pre and post operatively on the 2nd and 7th days respectively. Results: Regarding pain alleviation, diclofenac potassium was better than naproxen sodium and naproxen sodium was better than etodolac but these differences were not statistically significant. US measurements showed that the swelling on postoperative 2nd day was significantly lowest with diclofenac potassium as compared to others (p= 0.027) while naproxen sodium and etodolac acted similarly (p=0.747). No difference was noted regarding trismus in any of the groups. Conclusions: NSAIDs (diclofenac, naproxen and etodolac) are somehow similarly effective for controlling pain and trismus following extraction of mandibular third molars but diclofenac potassium surpasses others in reduction of swelling. Key words:Diclofenac potassium, naproxen sodium, etodolac, impacted third molar surgery, pain, swelling, trismus.

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Preoperative Intravenous Tramadol Versus Diclofenac for Preventing Postoperative Pain After Third Molar Surgery: A Comparative Study

Cited by 15 publications

References 8 publications

Pre-emptive analgesic efficacy of injected ketorolac in comparison to other agents for third molar surgical removal: a systematic review

Pre-emptive analgesic efficacy of injected ketorolac in comparison to other agents for third molar surgical removal: a systematic review

Preemptive application of QX-314 attenuates trigeminal neuropathic mechanical allodynia in rats

Comparison of the effect of Naproxen, Etodolac and Diclofenac on postoperative sequelsfollowing third molar surgery: A randomised, double-blind, crossover study

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