Efficacy of oral diclofenac with or without codeine for pain control after invasive bilateral third molar extractions

Gonçalves, Paulo Zupelari; Weckwerth, Giovana Maria; Calvo, Adriana Maria; Simoneti, Luis Fernando; Dionísio, Thiago José; Brozoski, Daniel; Torres, Elza Araujo; Lauris, José Roberto Pereira; Faria, Flávio Augusto Cardoso de

doi:10.1016/j.ijom.2017.01.008

Cited by 16 publications

(28 citation statements)

References 31 publications

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“…After 3 minutes and when the patient confirmed a loss of sensation of the lower lip, a half cartridge (0.9 mL) of local anesthetic was injected to obtain complete and consistent anesthesia. A half cartridge (0.9 mL) of local anesthetic was also administered using the terminal infiltration technique to reduce bleeding and ensure mucosal anesthesia 16–24…”

Section: Methodsmentioning

confidence: 99%

“…Oral rescue analgesic medication was also available as needed throughout the study; for that, 750 mg tablets of paracetamol were provided to all volunteers, who were instructed to record the time of consumption while maintaining the use of piroxicam 16–19,21–26…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, postoperative mouth opening (millimeters) between the mesial–incisal corners of the upper and lower right central incisors during maximum opening of the jaws was measured and recorded before surgery as well as during the second and seventh postoperative days, according to Ustun et al16,24,27…”

Section: Methodsmentioning

confidence: 99%

“…For swelling measurements of the facial edema, methods were used according to Ustun et al, which sums the following measures: 1) the distance between the lateral canthal ligament and the gonion; 2) the distance between the tragus and the labial commissure of the mouth; and 3) the distance between the tragus and the soft tissue of pogonion 16,24,27. The preoperative sum of these three measures was considered the baseline.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, this study aimed to evaluate the possible association of polymorphisms of CYP2C8*3, CYP2C9*2 and CYP2C9*3 with the clinical efficacy of oral piroxicam (20 mg daily for 4 days) after invasive lower third molar surgeries with regard to pain, swelling, trismus, need for rescue medication, volunteer satisfaction and adverse reactions to piroxicam. Briefly, the volunteers selected for this study required invasive surgeries for lower third molars with the following classifications: Pell and Gregory class IIB, IIC, IIIA, IIIB and IIIC and/or Winter horizontal, distal, inverted and transalveolar 16. It was hypothesized that postoperative pain would be effectively managed by a daily 20 mg oral dose of piroxicam for all genotypes, but that volunteers with mutant CYP2C8*3 and CYP2C9 genotypes would report less postoperative pain after lower third molar surgery.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with CYP2C8*3 and CYP2C9

Calvo

Zupelari-Gonçalves

Dionísio

et al. 2017

JPR

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ObjectiveNonsteroidal anti-inflammatory drugs (NSAIDs) are metabolized by the cytochrome P450 enzymes (CYPs), predominantly CYP2C8 and CYP2C9. The aim of this study was to evaluate the possible association of polymorphisms in the CYP2C8*3 and CYP2C9 genes with the clinical efficacy of oral piroxicam (20 mg daily for 4 days) after lower third molar surgeries with regard to postoperative pain, swelling, trismus, adverse reactions, need for rescue medication and the volunteer’s overall satisfaction.Materials and methodsFor this purpose, 102 volunteers were genotyped for CYP2C8*3 and CYP2C9 polymorphisms. Briefly, genomic DNA was isolated from saliva collected from volunteers subjected to invasive lower third molar surgeries, and the preoperative, intraoperative and postoperative parameters were collected and analyzed.ResultsAn equal amount of piroxicam sufficiently managed postoperative pain and inflammatory symptoms, with visual analog pain scores typically <40 mm for all genotypes investigated. Furthermore, only two out of 102 volunteers heterozygous for CYP2C8*3 and CYP2C9*3 reported adverse side effects.ConclusionIn general, slow metabolizers of piroxicam, who were volunteers with mutant alleles, were indifferent from normal metabolizers with the wild-type alleles and therefore did not require specialized piroxicam doses to manage postoperative pain and inflammation.

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Section: Methodsmentioning

confidence: 99%