A Prospective Study to Assess the Levels of Interleukin-6 Following Administration of Diclofenac, Ketorolac and Tramadol After Surgical Removal of Lower Third Molars

Abstract

Introduction The surgical removal of impacted third molars involves, trauma to soft and bony tissue and can result in considerable pain, swelling, and trismus. The greater the amount of tissue injury the greater is the amount of inflammation in the perisurgical region. Interleukin-6 (IL-6) is both a pro inflammatory and anti-inflammatory cytokine. It is secreted by T cells and macrophages to stimulate the immune response. IL-6 is also an early marker of tissue damage. In addition to NSAIDs, corticosteroids, opioids also have immunomodulatory effects. Aim To evaluate the changes in serum IL-6 levels following surgical removal of third molars under local anaesthesia after administration of two NSAIDs diclofenac and ketorolac and opioid tramadol post operatively. Methods Patients undergoing surgical removal of impacted mandibular third molar teeth were randomly assigned to three groups. Each group received one of the three analgesics viz diclofenac 50 mg, ketorolac 10 mg and tramadol 50 mg. The mean levels of IL-6 was then estimated by ELISA.Results The results of our study showed that all three drugs i.e. diclofenac, ketorolac and tramadol have properties which can downregulate the production of IL-6 in response to surgical trauma. Conclusion It is of clinical significance that the suppression of IL-6 values occurs in tramadol group closely following the diclofenac group. Even though the drug ketorolac suppresses the IL-6 levels similar to diclofenac initially but after 7 days tramadol and ketorolac showed similarities in suppression of IL-6 expression which is less compared to diclofenac group.

Variability in the Analgesic Response to Ibuprofen Is Associated With Cyclooxygenase Activation in Inflammatory Pain

“…Because cytokines were measured in serum, they might have been released from activated cells rather than representing circulating levels. In contrast with some prior studies, 36,37 ibuprofen treatment did not decrease IL-6 levels in our cohort. This may be due to differences in timing of sample collection, as our samples were collected ~ 3 and 5 hours after surgery, whereas effects of NSAIDs on cytokine levels have been observed at later time points (e.g., 12-24 hours after surgery).…”

Variability in the Analgesic Response to Ibuprofen Following Third-Molar Extraction is Associated with Differences in Activation of the Cyclooxygenase Pathway

“…However, it is also possible that these pathways are regulated in parallel, and additional studies are necessary to clarify whether there is a causal relationship between activation of the COX pathway and induction of TNF-α and IL-8 in vivo. In contrast to some prior studies [51,52], ibuprofen treatment did not decrease IL-6 levels in our cohort. This may be due to differences in timing of sample collection as our samples were collected approximately 3 and 5 hours after surgery, while effects of NSAIDs on cytokine levels have been observed at later time points (e.g.…”

Changes in Serum Levels of Il-6 in the Early Postoperative Period After Preemptive Analgesia With Nimesulide, Metamizole Sodium and Placebo in Removal of Impacted Mandibular Third Molars

“…The results obtained at postoperative hour 24 showed a significant increase in IL-6 levels compared to the pre-operative results. These findings are identical to the results of studies of some authors, according to whom IL-6 levels are highest at postoperative hour 24, and then decrease [14,19,20]. The analysis of the data obtained by us showed that the rise in IL-6 levels after surgical removal of impacted third molars was not higher than 14 pg/ml.…”

“…It is noteworthy that preoperative IL-6 levels were below the LOQ. This is in disagreement with studies by other authors [13,14]. In our opinion, the reason for this is the inclusion and exclusion criteria of the study, which were defined so to eliminate the phenomenon of central sensitization.…”

“…Some studies have shown that changes in IL-6 levels could be seen in oral surgery procedures [12]. There are relatively few studies of the use of this cytokine as a marker in surgical removal of mandibular third molars [13,14]. According to some authors, anti-inflammatory agents used also affect IL-6 concentration in the early postoperative period [15,16].…”