Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind, randomized, placebo-controlled study

Abstract

This study aimed to evaluate whether pre-emptive analgesia modifies the tissue expression of tumour necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β), and whether there is an association with postoperative surgical outcomes. A triple-blind, randomized, placebo-controlled study of patients undergoing mandibular third molar removal was performed. Volunteers were allocated randomly to receive etoricoxib 120 mg, ibuprofen 400 mg, or placebo 1h before surgery. Twenty-four surgical sites per group were required (95% confidence level and 80% statistical power). Pain scores differed significantly between groups (P<0.001). Etoricoxib and ibuprofen reduced pain scores compared to placebo (P<0.05). Pain scores peaked at 4h postoperative in the experimental groups, but at 2h postoperative in the placebo group (P<0.05). A significant reduction in TNF-α concentration from time 0' to time 30' was seen for ibuprofen (P=0.001) and etoricoxib (P=0.016). The ibuprofen group showed a significant reduction in IL-1β levels from time 0' to time 30' (P=0.038). In conclusion, TNF-α and IL-1β levels and the inflammatory events in third molar surgery were inversely associated with the degree of cyclooxygenase 2 selectivity of the non-steroidal anti-inflammatory drugs used pre-emptively. Patients given pre-emptive analgesia showed significant reductions in the clinical parameters pain, trismus, and oedema when compared to the placebo group.

RT-qPCR study of COX-1 and -2 genes in oral surgical model comparing single-dose preemptive ibuprofen and etoricoxib: A randomized clinical trialy

“…-Study Design and Sample size calculation This study had an analytical design. Gingival tissue was collected during extraction of impacted lower third molars from patients, during the course of a previous clinical trial that had a randomized, triple-blind, split-mouth and placebo-controlled study design (11). The following inclusion criteria were adopted to standardize the level of traumatic injury generated by surgery: patients with third molars requiring ostectomy, with or without associated tooth sectioning; patients with third molars that showed similar patterns of root formation, position, and degree of impaction.…”

“…The following inclusion criteria were adopted to standardize the level of traumatic injury generated by surgery: patients with third molars requiring ostectomy, with or without associated tooth sectioning; patients with third molars that showed similar patterns of root formation, position, and degree of impaction. In addition, the following exclusion criteria were adopted: smokers, pregnant or breast feeding, users of medications that could interact with the drugs used in this study, patients with orthodontic bands on the mandibular second molars, confirmed history of allergy to NSAIDs, signs of any preoperative inflammatory or infectious condition, systemic chronic disease, use of NSAIDs within the past 21 days, or the presence of periodontal disease, swelling, fever, or trismus prior to surgery (11). The previous study was approved by the Ethics Committee of the Walter Cantídio University Hospital (WCUH) No.…”

“…The data obtained established that a minimum sample size of 5 surgical sites per group yields a power of 90%, and al-pha=0.05 in order to accept or reject the null hypotheses. To obtain the minimum sample size per group from the original study carried out by Albuquerque et al (11) a second randomization was performed using a method to generate the random allocation sequence ("randomization per block" function of the Microsoft Excel®).…”

Involvement of P2X7 receptors in satellite glial cells of dorsal root ganglia in the BmK I -induced pain model of rats

“…It might be suspected that there may be a similar post-transcriptional feedback mechanism in DRG which inhibits the continual increasing of P2X7R protein in the BmK I model. It has been generally assumed that pro-inflammatory cytokines, including IL-1β and TNF-α, play an important role in the initiation and maintenance of inflammatory (Albuquerque et al 2017) and neuropathic pain (Xie et al 2017; Wu et al 2017b). It has been demonstrated that P2X7 receptors can mediate the release of IL-1β (Burnstock and Knight 2018).…”

Preemptive analgesia-related gene and protein expression in third molar surgeries under non steroidal anti-inflammatory drug protocols: A PROSPERO-registered systematic review of clinical studies

“…The evaluation of specific gene expression has been widely used as an important tool in studies in the field of dentistry, including translational investigations to determine diagnostic approaches, as well as to evaluate pharmacology-based drug protocols commonly utilized in clinical situations ( 1 , 2 ). In addition, genetic analyses through observation of messenger RNA (mRNA) expression or the measurement of specific mediators such as cytokines have produced important findings that support a relationship between tissue damage, degree of inflammatory response, and onset of clinical related events such as pain and edema in surgical procedures for the removal of third molars ( 3 - 5 ).…”