Preoperative Piroxicam for Postoperative Analgesia in Dental Surgery

Abstract

Fifty patients were allocated randomly to receive placebo or piroxicam 40 mg, 2.5 h before surgical removal of lower third molars under general anaesthesia. A significantly greater number of patients in the piroxicam group did not require opioid analgesia after operation (P less than 0.05). The piroxicam group also required fewer doses of paracetamol in the first 24 h after recovery from anaesthesia (P less than 0.05), and the time from recovery to first postoperative analgesia was longer in those patients who had received piroxicam (P less than 0.05). Piroxicam did not significantly prolong the duration of recovery from anaesthesia.

Pre-emptive analgesia: importance of timing

“…Of the 18 randomized, single-or double-blind studies that used an NSAID as the target intervention, five evaluated broad pre-emptive effects, [17][18][19][20][21] nine evaluated narrow pre-emptive effects, 13,[22][23][24][25][26][27][28][29] and four both broad and narrow effects. [30][31][32][33] Studies of patients undergoing oral surgery such as third molar extraction 17,18,20,[22][23][24][25] or pulpectomy 3 0 were among the earliest to be conducted. More recently, other procedures have been studied, including abdominal hysterectomy, 26,33 orthopedic surgery, 21,27,28,31,32 laparoscopy, 1 9 and breast biopsy.…”

Pre-incisional caudal epidural blockade and the relief of pain after lumbar spine operations

“…This can be achieved by preventing pain hypersensitivity which can arise from two phases of sensory input from tissue damage, namely from stimuli directly from tissue damage or else associated with the inflammatory reaction to tissue damage occurring at hours or days after operation. Pre-emptive analgesia should eliminate both these phases of afferent input [1,8,9,12,15].…”

An assessment of morphine requirement after wisdom tooth extraction under general anaesthesia

“…Further studies are currently in progress to adjust both surgical and anaesthetic techniques in order to reduce the postoperative analgesic+requirements of these patients. A clear airway can be obtained by use of the Brain laryngeal mask airway [ 1,2]. Aperture bars in the bowl of the mask are designed to elevate the epiglottis and to protect against its migration into the mask aperture, an event that could lead to obstruction of the airway.…”

“…However, it is known that even opioids may fail to provide adequate pain relief when given in standard intramuscular regimens such as 4-hourly papaveretum 0.2 mg.kg-' or morphine 0.2 mg.kg-l [l]. In the absence ofknowledge about absolute analgesic requirements following this procedure, existing regimens are quite likely to provide inadequate pain relief [2].…”

“…The majority have compared non-steroidal antiinflammatory drugs (NSAIDs) with placebo, with other drugs of the same class, or with an opioid analgesic [1][2][3][4][5][6]. Some have used a standard intramuscular on-demand opioid given at the point of inadequate pain relief following the trial drug and calculated the amount of opioid analgesia received in the 24 h postoperatively [l, 21. However, absolute measurements of the analgesic requirements following dental extraction cannot be obtained from these studies.…”