Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial

Abstract

BackgroundPreemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery.Material and MethodsA parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects.ResultsPatients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol.ConclusionsAccording to the VAS and AUC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery. Key words:Ketorolac, tramadol, third molar surgery, pain, preemptive analgesia.

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

“…Oral Etirocoxib [10,22], celecoxib [11], acetaminophen [11], dexamethasone [17,21,24,25,35,36,39], diclofenac [17,36], codeine [17], ketorolac [19,21,43], methylprednisolone [25,35], paracetamol [26,48], dexketoprofen [26], ibuprofen [39,47,48], tramadol [40], nimesulide [40], ketoprofen [44], diflunisal [46], lornaxicam [46], rofecoxib [47].…”

Efecto antiinflamatorio de la asociación dexametasona con ketorolaco o diclofenaco en cirugía de tercer molar. Ensayo clínico aleatorizado

“…14 e Isiordia-Espinoza y cols. 6 mencionan que modula los receptores opioides y estimula la liberación de óxido nítrico. El ketorolaco es un inhibidor preferencial de la ciclooxigenasa 1 (COX-1), que se expresa constitutivamente y participa en la homeostasis de los procesos fisiológicos; sin embargo, también está presente durante el inicio del dolor posterior a cirugía de tercer molar 15 .…”

“…El diclofenaco es un AINE que por sus características farmacocinéticas y farmacodinámicas controla adecuadamente la tumefacción facial y el dolor postquirúrgicos 3 . El ketorolaco es otro AINE que ha evidenciado un adecuado efecto analgésico durante las primeras horas del postquirúrgico inmediato 6 .…”

Use of viminol in acute pain management after third molars extraction. Case report

“…But the choice of a synthetic molecule with a similar analgesic power to codeine was a determining factor for therapeutic success. Several authors 15,21,22 reported that pre-operative administration of analgesics reduce pain conditions in the immediate post-op, and suggest that preventive analgesia is an alternative for acute postoperative pain control in third molar extractions 23 . The preventive approach is started even before a painful stimulus is generated, thus preventing or even decreasing subsequent pain and the onset of CNS alterations during the surgical act [21][22][23][24] .…”

“…Several authors 15,21,22 reported that pre-operative administration of analgesics reduce pain conditions in the immediate post-op, and suggest that preventive analgesia is an alternative for acute postoperative pain control in third molar extractions 23 . The preventive approach is started even before a painful stimulus is generated, thus preventing or even decreasing subsequent pain and the onset of CNS alterations during the surgical act [21][22][23][24] . In this line of reasoning, a preventive approach would be to start treatment with the association of HV (70mg) and paracetamol (750mg) 1 hour prior to surgery, to allow better bioavailability of the drug and therefore better postoperative analgesia, considering that both drugs act in synergy and promote comfort to the patient, without running the risk of genetic polymorphism.…”