Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane, Amith; Shankariah, Manjunath; Neswi, Kiran V.

doi:10.1007/s12663-015-0813-2

Cited by 16 publications

(9 citation statements)

References 39 publications

(71 reference statements)

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“…Hadhimane et al . [ 12 ] in their study found that submucosal ketamine given 0.5 mg/kg in a bilateral split mouth third molar surgery model was effective in significantly reducing postoperative pain for the first 24 hrs compared to a placebo.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of preemptive analgesia of dextromethorphan and ibuprofen in third molar surgeries

Kale

Shetty

Moin

et al. 2020

Ann Maxillofac Surg

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Introduction: Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective. Objective: The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries. Material and Methods: Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively. Results: The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1 st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients. Conclusion: DM premedication is a viable preemptive analgesic in reducing postoperative pain.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of preemptive analgesia of dextromethorphan and ibuprofen in third molar surgeries

Kale

Shetty

Moin

et al. 2020

Ann Maxillofac Surg

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“…According to the study conducted by Satilmus et al . [ 1 ] and Hadimane et al .,[ 11 ] pain was comparatively less with administration of LAK compared to LAA. Postoperative facial swelling was assessed in both the groups using tape-measure method, results suggest that the swelling on the 3 rd (1.01 ± 0.21) and 7 th day (0.9 ± 2.44) postoperatively was significantly reduced in the LAK group as compared to the LAA group (2.16 ± 1.47) and (1.96 ± 1.43) [ Table 3 ].…”

Section: Discussionmentioning

confidence: 99%

Combination of articaine and ketamine V/S articaine alone after surgical extraction of impacted third molars

Dubey

Singh

Sharma

et al. 2020

Ann Maxillofac Surg

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Objective: Local anesthetics are the most effective drugs available for the management of pain while performing operative procedures. This study was performed to compare the clinical efficacy of treatment with local anesthetic articaine (4%) with ketamine and local anesthetic articaine alone (4%) for the relief or prevention of postoperative pain, swelling, and trismus after the surgical extraction of impacted mesioangular third molars. Materials and Methods: Sixty patients undergoing the extraction of impacted mesioangular mandibular third molars were included in the study. The patients were randomly divided into two groups: local anesthetic alone (LAA) and local anesthetic plus ketamine (LAK). Results: Facial swelling following surgery on postoperative days was significantly lower in the LAK group than in the LAA group on 3 rd and 7 th postoperative days ( P < 0.05). Mouth opening on the postoperative days was significantly greater in the LAK group than in the LAA group on 3 rd and 7 th postoperative days ( P < 0.05). The pain scores on the visual analog scale at 30 min and 1 h, 4 h, 12 h, and 24 h after the surgery were significantly higher in the LAA group than in the LAK group and there was no significant difference in heart rate, oxygen saturation, and blood pressure in both the groups. Conclusion: In this present study, the effect of articaine with ketamine in comparison with articaine alone intraoperatively and postoperatively was observed, and it revealed that the combination of articaine with ketamine produced good local anesthesia and provide good postoperative analgesia with less swelling and significantly less trismus.

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“…Both medication options have been shown to be more effective than placebo and have been tested extensively as evidenced by several prior systematic reviews [17,19,[27][28][29][30][31][32][33][34][35][36]. Completed studies, however, are limited for the following reasons: they only compared the specific analgesic drug against a placebo; they frequently utilize a single dose which may miss the peak post-surgical pain period [37]; they wait for the onset of pain before administering the analgesic drug; they do not consider sex differences [37][38][39][40][41]; they do not examine heterogeneity issues; they have small sample sizes and do not test for non-inferiority [42,43]; they use dosages that are either not commercially available, or enable patients to easily exceed the recommended US Federal Drug Administration (FDA) maximum dosage; and/or they follow patients for just several hours after surgery [34]. Furthermore, those earlier studies looked primarily at pain outcomes, prohibited other commonly prescribed treatments like corticosteroids, and limited the extractions to either 2 molars or 4 molars.…”

Section: Previous Study Weaknessesmentioning

confidence: 99%

The Opioid Analgesic Reduction Study (OARS)—a comparison of opioid vs. non-opioid combination analgesics for management of post-surgical pain: a double-blind randomized clinical trial

Feldman

Fredericks-Younger

et al. 2022

Trials

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Background Everyday people die unnecessarily from opioid overdose-related addiction. Dentists are among the leading prescribers of opioid analgesics. Opioid-seeking behaviors have been linked to receipt of initial opioid prescriptions following the common dental procedure of third molar extraction. With each opioid prescription, a patient’s risk for opioid misuse or abuse increases. With an estimated 56 million tablets of 5 mg hydrocodone annually prescribed after third molar extractions in the USA, 3.5 million young adults may be unnecessarily exposed to opioids by dentists who are inadvertently increasing their patient’s risk for addiction. Methods A double-blind, stratified randomized, multi-center clinical trial has been designed to evaluate whether a combination of over-the-counter non-opioid-containing analgesics is not inferior to the most prescribed opioid analgesic. The impacted 3rd molar extraction model is being used due to the predictable severity of the post-operative pain and generalizability of results. Within each site/clinic and gender type (male/female), patients are randomized to receive either OPIOID (hydrocodone/acetaminophen 5/300 mg) or NON-OPIOID (ibuprofen/acetaminophen 400/500 mg). Outcome data include pain levels, adverse events, overall patient satisfaction, ability to sleep, and ability to perform daily functions. To develop clinical guidelines and a clinical decision-making tool, pain management, extraction difficulty, and the number of tablets taken are being collected, enabling an experimental decision-making tool to be developed. Discussion The proposed methods address the shortcomings of other analgesic studies. Although prior studies have tested short-term effects of single doses of pain medications, patients and their dentists are interested in managing pain for the entire post-operative period, not just the first 12 h. After surgery, patients expect to be able to perform normal daily functions without feeling nauseous or dizzy and they desire a restful sleep at night. Parents of young people are concerned with the risks of opioid use and misuse, related either to treatments received or to subsequent use of leftover pills. Upon successful completion of this clinical trial, dentists, patients, and their families will be better able to make informed decisions regarding post-operative pain management. Trial registration ClinicalTrials.govNCT04452344. Registered on June 20, 2020

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Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Cited by 16 publications

References 39 publications

Comparative evaluation of preemptive analgesia of dextromethorphan and ibuprofen in third molar surgeries

Comparative evaluation of preemptive analgesia of dextromethorphan and ibuprofen in third molar surgeries

Combination of articaine and ketamine V/S articaine alone after surgical extraction of impacted third molars

The Opioid Analgesic Reduction Study (OARS)—a comparison of opioid vs. non-opioid combination analgesics for management of post-surgical pain: a double-blind randomized clinical trial

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