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

Abstract

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.

Efficacy and Safety of Oral Diclofenac Sustained release Versus Transdermal Diclofenac Patch in Chronic Musculoskeletal Pain: A Randomized, Open Label Trial

“…In a study by Prithvi S Bachali et al . [ 10 ] where in transdermal diclofenac diethylamine (100 mg) patch group provided similar analgesia as oral diclofenac (100 mg) SR following the removal of mandibular impacted third molars on second and third postoperative day as measured on VAS.…”

“…In one study, plasma levels achieved by transdermal patch ranged between 20 and 50 ng/ml, which was lesser when compared to the oral route, but these levels were sustained for a longer time. [ 10 ] One study has reported that the amount of drug bioavailable for targeting the sites of action is lower than oral route, but the absorbed dose appears to be adequate for therapeutic use. [ 19 ] In one in vitro study carried out in rats, patches were subjected to in vitro permeation enhancement studies through rat skin using, an especially designed diffusion cell.…”

Efficacy of transdermal diclofenac patch as an analgesic following premolar extractions in orthodontic patients

“…This is also in accordance with Prithvi et al . [ 1 ] who included twenty patients in which 13 were male (65%) and 7 (35%) were female.…”

“…On comparison of the pain at VRS between two groups and also within group comparison using Friedman test, in the diclofenac patch group, the difference in VRS pain scale at different visit was statistically significant with P = 0.001. This finding is in agreement with the study done by Prithvi et al .,[ 1 ] who evaluated 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. They used VAS and VRS scales for the evaluation and concluded that transdermal diclofenac sodium can be used as an alternative form of pain control following the removal of impacted mandibular third molars.…”

“…The premise of successful treatment is based not only on the correct operative technique but also on the prevention and management of postoperative complications such as pain and swelling. [ 1 ] The international association for the study of pain has defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”[ 2 ]…”