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

Abstract

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 ± 4.36 and 93.12 ± 3.70% of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 ± 91.21 and 461.54 ± 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 ± 1.84 and 8.46 ± 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 ± 1.61 and 2.23 ± 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.

Comparative analysis of preemptive analgesic effect of dexamethasone and diclofenac following third molar surgery

“…The mean time of action of lidocaine (2%) with epinephrine (1:100,000), used in this study, and of mepivacaine are lower than that of articaine. 13 Therefore, extending the anesthetic effect was a determinant in shifting the algic peak, as observed in this study.…”

“…Both steroidal and non-steroidal analgesic drugs act by inhibiting the same chain reactions that degrade phospholipids of injured cell membranes, responsible for the algic and inflammatory response. [13][14][15] Insofar as pain and inflammation are consequences of the release of chemical mediators produced after tissue trauma, it would be reasonable to conclude that preemptive medication contributes to lowering the concentration of these mediators in tissue, considering that the presence of the drug in the blood stream inhibits their initial production. As a result, the lower the tissue concentration of these mediators, the weaker the algic and inflammatory response.…”

“…17 However, some authors 13 reported an algic peak around the 5 th hour after surgery. This could be explained by the action of the anesthetic agent used to perform the nerve blockage.…”

Comparison of oral versus sublingual piroxicam during postoperative pain management after lower third molar extraction

“…Pregnant women were excluded from the study. Instructions for not using antidepressants, diuretics, aspirin or antibiotics 7 days prior to surgery were given to the patients, avoiding possible hemorrhage or other possible unwanted interactions with the drugs used in this investigation 3,5,6,11,19,34 .…”

“…This surgical procedure is a well accepted model used to evaluate the clinical efficacy of anesthetics and antiinflammatory drugs 1,3,5 . When patients receive no analgesic medication they report a pain score of 80 on a visual analog scale (VAS) from 0 to 100 cm with zero representing 'no pain' and 100 representing 'the worst pain imaginable' 3,28 . It is necessary to manage pain for this surgery and this study did not use a placebo as a negative control.…”