Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

Abstract

Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin ® ) when compared with 20 mg piroxicam alone (Feldene ® ) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/ benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal

“…The percentage of patients taking rescue medication was also very similar to that reported in another study assessing the clinical efficacy of valdecoxib, that is, about 32% (27). These results confirm the analgesic efficacy of piroxicam and valdecoxib after lower third molar removal (13,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”

“…In the current study, we performed a further characterization of the clinical efficacy of both valdecoxib and piroxicam focusing not only on postoperative pain relief (13,(23)(24)(25)(26)(27)(28)(29), but also on trismus and swelling control. Both drugs were equally effective for trismus control.…”

“…The measurements of facial swelling found in the study of Üstün et al (2), who prescribed two different doses of a corticosteroid for swelling control, were very similar to ours both on the 2nd and 7th postoperative days (about 7 and 3 mm, respectively). Corticosteroids are well known as potent drugs widely used to decrease the swelling related to third molar surgery (2,24).…”

“…Among the NSAIDS used in dentistry, piroxicam, a non-selective COX inhibitor, has been extensively studied (20)(21)(22)(23)(24). In contrast, there are only seven reports in the dental literature concerning the clinical use of valdecoxib, a COX-2 selective inhibitor, for postoperative pain control in patients who undergo dental surgeries (13,(25)(26)(27)(28)(29)(30).…”