Non‐steroidal anti‐inflammatory drugs for pain after oral surgery

Abstract

Aim: To describe the role of non-steroidal anti-inflammatory drugs (NSAIDs) in the management of pain after oral surgery. Materials and methods: A review of the literature describing the pharmacokinetics, benefits and harms of NSAIDs in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. Results: Twelve Cochrane reviews were identified describing the efficacy of NSAIDs for pain after oral surgery. Ibuprofen 400 mg is an effective analgesic [number needed to treat (NNT) = 2.3 in tablet form and 1.8 in soluble form]. Cyclooxygenase-2 (COX-2)-selective NSAIDs also demonstrate low NNTs, based on smaller studies of post-operative pain. There is association with gastrointestinal, cardiovascular and renal adverse effects. Conclusions: NSAIDs are effective analgesics for moderate pain after oral surgery. The routine use of COX-2-selective NSAIDs is not recommended. Careful patient selection is important. Clinical relevance Scientific rationaleThis article provides an update for oral surgeons on the use of non-steroidal anti-inflammatory drugs (NSAIDs) for post-operative pain control. Principal findingsThere are many NSAIDs that are currently licensed around the world, and they have different indications and modes of action. We recommend ibuprofen and diclofenac as the most effective NSAIDs for pain after oral surgery. Practical implicationsNSAIDs are very useful analgesics for managing postoperative pain; however, their adverse effects must be borne in mind when prescribing, and it is advisable to use the lowest effective dose for the shortest possible duration.

Uso De Analgésicos Y Antiinflamatorios en Un Servicio De Cirugía Bucal en Medellín, 2013-2015

“…This is an important aspect during prescription due to the risk of gastrointestinal damage associated with NSAID treatments, dependent on factors like dose, combination of more than one NSAIDs, simultaneous use of aspirin, concomitant use of corticosteroids, and patients treated with anticoagulants or antiplatelet agents. 23 Another side effect associated with the consumption of non-selective NSAIDs is inhibition of platelet aggregation as a result of the reduction of thromboxane A2 synthesis, thereby altering hemostasis. 47 Five patients in this study were taking ibuprofen at the time of surgery; it is unknown for how long they had been doing so, but apparently an earlier consumption three days prior to surgery does not increase the postoperative bleeding in extraction of third molars.…”

The Effect of Type and Dose of Anti-Inflammatory Drugs on the Viability and Osteogenic Potential of Dental Pulp Stem Cells

“…The effect of NSAIDs manifests itself very soon after the patient had consumed them and the full effect occurs within one week. 4 NSAIDs are safe, well tolerated and are considered the first choice among analgesics for patients undergoing surgical procedures but they can delay or impair bone healing at certain critical stages in the healing process. 5 Dental pulp stem cells (DPSCs) are colonies of highly proliferative fibroblastic-like shaped cells with high frequency of colony-forming and a high rate of proliferation.…”