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

Abstract

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.

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

“…Intramuscular Dexamethasone [10], diclofenac [18,27], ketorolac [18,30], tramadol [19,30,42,45], ketoprofen [27], meloxicam [42], 3.…”

The Outcome of Preoperative Administration of Single-Dose Ketorolac, Ibuprofen 400mg and Placebo on Postoperative Pain in Teeth with Irreversible Pulpitis and Apical Periodontitis

“…However, its analgesic efficacy is controversial, with reports that its effect is similar [23] or less good [24] that of non-steroidal anti-inflammatory drugs (NSAID). According to these findings a single dose of tramadol has some relatively usual unfavorable effects [25]. The purpose of this study was to compare the outcome of preoperative administration of single-dose ketorolac, ibuprofen 400mg and placebo on postoperative pain in teeth with irreversible pulpitis and apical periodontitis.…”

Sublingual Piroxicam as Preemptive Analgesia in Single Implant Surgery

“…In addition, the author also found less cumulative opioid consumption in the study group patients treated with preemptive sublingual piroxicam. Shah et al 9 evaluated the analgesic efficacy of intramuscular ketorolac following the third molar surgery and concluded that prolonged duration of pain relief with intramuscular ketorolac signifies the existence of preemptive analgesia.…”