Effect of preemptive analgesia with ibuprofen in the control of postoperative pain in dental implant surgeries: A randomized, triple-blind controlled clinical trial

Abstract

Background: Preemptive analgesia has as its basic principle the administration of analgesics before the onset of painful stimuli, in order to reduce or prevent postoperative pain, but this question is little explored in implantology. Thus, this study was conducted in order to evaluate the clinical efficacy of ibuprofen in pain prevention after unit implant surgery. Material and Methods: For this triple-blind, parallel, placebo-controlled and randomized clinical trial, 54 insertion surgeries of unitary implants were performed. Two groups have received two different protocols 1 hour before surgery: Ibuprofen group (IBU) 600 mg of ibuprofen; and (2) placebo group (maize starch). The intensity of the pain was evaluated through the visual analogue scale (VAS) in 6 times (1, 6, 12, 24, 48 and 72 hours after the surgery). Patients were instructed to take 750 mg of paracetamol as rescue medication, if necessary. The occurrence and the intensity of pain were analyzed by means of an analysis of variance ANOVA with repeated measurements using the general linear model procedure. Results: The IBU group had significantly lower VAS scores overall (IBU = 0.30, ± 0.57; placebo = 1.14, ± 1.07; p<0.001) and at all times in the intra, intergroup comparisons and time/group interaction than the placebo group (p< 0.001). The use of rescue medication was significantly lower and the postoperative time was longer in the IBU group compared to placebo (p = 0.002). Conclusions: The single use of ibuprofen was found to be significantly superior in reducing pain after unit implant surgery compared to placebo.

Wedge-Shaped Implants for Minimally Invasive Treatment of Narrow Ridges: A Multicenter Prospective Cohort Study

“…Standard implant surgeries are usually related to low pain scores: Kim et al [ 47 ] demonstrated that postoperative pain and discomfort are proportional to the duration of the surgical procedure and the number of implants placed. The mean VAS pain score recorded in the present study is similar to those recorded in other studies investigating single standard implant insertion with drilling [ 48 , 49 ] or ultrasonic technique [ 50 ]. In accordance with these outcomes, VAS pain score was classified as mild pain on the day of surgery and the first postoperative day and no pain over the following five days.…”

Analgesics for Dental Implants: A Systematic Review

“…Of these, five were excluded due to different interventions (three studies) or unavailability of results (two ongoing studies). No additional articles were identified via hand search; thus, a total of 11 RCTs ( Pereira et al, 2020 ; Bhutani et al, 2019 ; Iero et al, 2018 ; Sánchez-Pérez et al, 2018 ; Bahammam et al, 2017 ; Meta et al, 2017 ; Samieirad et al, 2017 ; Raja Rajeswari et al, 2017 ; Li et al, 2015 ; Bölükbasi et al, 2012 ; Karabouda et al, 2007 ) were included in the qualitative synthesis ( Figure 1 ). Cohen’s kappa indicated a substantial inter-rater agreement (kappa 0.72).…”

“…The timing of administration varied from 24 h before surgery to 72 h after surgery. Outcome measures of interest included postoperative pain (11 studies) ( Pereira et al, 2020 ; Bhutani et al, 2019 ; Iero et al, 2018 ; Sánchez-Pérez et al, 2018 ; Bahammam et al, 2017 ; Meta et al, 2017 ; Samieirad et al, 2017 ; Raja Rajeswari et al, 2017 ; Li et al, 2015 ; Bölükbasi et al, 2012 ; Karabouda et al, 2007 ), swelling (two studies) ( Bhutani et al, 2019 ; Samieirad et al, 2017 ), patient’s satisfaction (four studies) ( Iero et al, 2018 ; Bahammam et al, 2017 ; Raja Rajeswari et al, 2017 ; Bölükbasi et al, 2012 ; Bahammam et al, 2017 ; Raja Rajeswari et al, 2017 ; Bölükbasi et al, 2012 ; Karabouda et al, 2007 ), and need for rescue medication (six studies) ( Pereira et al, 2020 ; Iero et al, 2018 ; Bahammam et al, 2017 ; Raja Rajeswari et al, 2017 ; Bölükbasi et al, 2012 ; Karabouda et al, 2007 ). Occurrence of adverse events was reported in six studies ( Pereira et al, 2020 ; Iero et al, 2018 ; Sánchez-Pérez et al, 2018 ; Bahammam et al, 2017 ; Raja Rajeswari et al, 2017 ; Bölükbasi et al, 2012 ).…”

“…Four studies [ Sánchez-Pérez et al, 2018 ; Samieirad et al, 2017 ; Bölükbasi et al, 2012 ; Karabouda et al, 2007 ) were at low risk of bias for all domains and were judged to be at low overall risk of bias. Five studies ( Pereira et al, 2020 ; Iero et al, 2018 ; Bahammam et al, 2017 ; Meta et al, 2017 ; Li et al, 2015 ) raised some concerns due to risk of bias arising from the randomization process (unclear information about concealment of allocation sequence and/or presence of baseline imbalances). One study ( Bhutani et al, 2019 ) was at high risk of bias arising from the randomization process (allocation sequence was not concealed) and was judged to be at high overall risk-of-bias.…”

“…All eleven studies investigated postoperative pain as reported by patients using visual analogue scale (VAS) [ Pereira et al, 2020 ; Bhutani et al, 2019 ; Sánchez-Pérez et al, 2018 ; Bahammam et al, 2017 ; Meta et al, 2017 ; Samieirad et al, 2017 ; Li et al, 2015 ; Karabouda et al, 2007 ) or ordered scales ( Iero et al, 2018 ; Raja Rajeswari et al, 2017 ; Bölükbasi et al, 2012 ) ( Table 2 ). Lower postoperative pain was reported with ibuprofen vs. placebo ( Pereira et al, 2020 ; Bahammam et al, 2017 ), piroxicam vs. placebo ( Bhutani et al, 2019 ), standard care + liposomal bupivacaine vs. standard care ( Iero et al, 2018 ), dexketoprofen trometamol vs. placebo ( Sánchez-Pérez et al, 2018 ), dexamethasone vs. placebo ( Bahammam et al, 2017 ), codeine vs. caffeine ( Samieirad et al, 2017 ), dexmedetomidine + fentanyl vs. midazolam + fentanyl ( Li et al, 2015 ), and lornoxicam vs. placebo ( Bölükbasi et al, 2012 ). No statistically significant difference was reported between ibuprofen and dexamethasone ( Bahammam et al, 2017 ), ketorolac vs. ketorolac + betamethasone ( Meta et al, 2017 ), and meloxicam vs. teloxicam ( Karabouda et al, 2007 ).…”