Effect of pretreatment with ketorolac tromethamine on post‐operative pain following periodontal surgery

Abstract

A double-blind, randomized, single-dose clinical trial to evaluate the analgesic efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was designed. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group received placebo. Naproxen sodium was allowed postoperatively as rescue medication. The visual analog scale was used to estimate pain. Postoperative pain was assessed hourly for the first 10 h on the day of surgery, and 4 x daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to placebo. Incidence and amount of naproxen consumption was similarly small in both ketorolac- and placebo-treated groups. No adverse reactions related to preoperative medication were observed.

Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta‐analysis

“…Injury to tissue during surgical procedures results in the release of chemical mediators of inflammation. Some of these mediators evoke pain (histamine, acetylcholine and bradykinin), and others (such as prostaglandins) cause hyperalgesia, which is characterized by decreased pain threshold and increased sensitivity to supra threshold stimuli (Trombelli et al, 1996). The preoperative administration of NSAIDs may augment postoperative analgesia, as seen in the present study (95% CI, À0.61 to À0.14; 31 comparisons), chiefly by the COX-2 inhibitors class (95% CI, À0.95 to À0.33; 13 comparisons), by preventing the establishment of central sensitization in nociceptive pathways (Higgins et al, 1994;Celik et al, 2005).…”

“…Three RCTs used ketorolac [one study, high dose (Higgins et al, 1994); two studies, medium dose (Trombelli et al, 1996;Wilder-Smith et al, 2003)], two used acetaminophen [one study, high dose (Dahl et al, 1997); one study, medium dose (Kesimci et al, 2011)], one used diclofenac sodium (one study, medium dose; Alanoglu et al, 2005) and one used etofenamate (one study, high dose; Sen et al, 2009a; Table 1). All seven RCTs compared a single NSAID group to a single placebo group (Table 1).…”

“…S4 (Dahl et al, 1996;Trombelli et al, 1996;Mayson et al, 2000;Celik et al, 2005;Chiu and Cheung, 2005;Kinney et al 2011;Short et al, 2012)]. …”

The Efficacy of Acetaminophen–Caffeine Compared to Ibuprofen in the Control of Postoperative Pain After Periodontal Surgery: A Crossover Pilot Study

“…Although the surgical extraction of impacted third molars is the most widely accepted model to compare the efficacy of analgesics and anti‐inflammatory drugs, the prevention and control of pain after periodontal surgeries are also of great concern for patients and clinicians. Several studies 21–25 have investigated different NSAIDs for this purpose, but to the author's knowledge there was no available study on the use of acetaminophen‐caffeine after periodontal surgery.…”

“…Many studies used a VAS 15,22,23,35 or the VRS‐4 21,24,25 for rating the patient's pain perception during a 3‐ to 10‐hour period of pain evaluation. The present study represents a contribution not using a VAS, recording pain during the first 8 hours as well as three times on the following day and finding an alternative for ibuprofen in case of a contraindication.…”