Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti- Inflammatory Medications

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post- diagnosis was determined, and the rates were compared using a chi-square analysis. Results: 10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion after 60 days post-diagnosis. Conclusion: The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.

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Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti-Inflammatory Medications

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00326 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0032

Author(s):

Brandon Barnds ◽

G. Matthew Heenan ◽

Armin Tarakemeh ◽

Scott M. Mullen ◽

John Paul Schroeppel ◽

...

Keyword(s):

Fracture Healing ◽

Delayed Union ◽

Chi Square ◽

Number Of Patients ◽

Icd 10 ◽

Metatarsal Fractures ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Chi Square Analysis ◽

Specific Fracture

Objectives: Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post-diagnosis was determined, and the rates were compared using a chi-square analysis. Results: 10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion at after 60 days post-diagnosis. Conclusion: The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.

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Comparison of the rate of delayed/nonunion in fifth metatarsal fractures receiving anti-inflammatory medications

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00435-x ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Brandon Barnds ◽

Matt Heenan ◽

Jack Ayres ◽

Armin Tarakemeh ◽

J. Paul Schroeppel ◽

...

Keyword(s):

Acute Effect ◽

Delayed Union ◽

Nonoperative Treatment ◽

Level Of Evidence ◽

Significant Difference ◽

Fracture Nonunion ◽

Metatarsal Fractures ◽

Icd Codes ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Purpose Controversy exists regarding the acute effect of non-steroidal anti-inflammatory drugs (NSAIDs) on early fracture healing. The purpose of this study was to analyze the rate of nonunion or delayed union in patients with fifth metatarsal (5th MT) fractures. We hypothesize that the use of NSAIDs would increase the rate of nonunion/delayed union in 5th MT fractures. Methods Using PearlDiver, a national insurance database was analyzed. ICD codes were used to identify patients diagnosed with 5th MT fracture from 2007-2018. Patients were grouped by initial management (nonoperative vs. open reduction and internal fixation (ORIF) or non/malunion repair within 60 days) and sub-grouped by whether they had been prescribed at least one pre-defined NSAID. Subsequent ORIF or nonunion/malunion repair operative intervention was used as a surrogate for fracture nonunion/delayed union. Results Of the 10,991 subjects with a diagnosis of 5th MT, 10,626 (96.7%) underwent initial nonoperative treatment, 1,409 of which (13.3%) received prescription NSAIDS within 60 days of diagnosis. 16/1,409 (1.14%) subjects who received anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis while 46/9,217 (0.50%; P=0.003483) subjects who did not receive anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis. In the 365 subjects who underwent early repair/ORIF (within 60 days), there was no significant difference in the rate of nonunion/delayed union. Conclusion The rate of nonunion/delayed union of 5th MT fractures was significantly higher in subjects receiving NSAIDs within 60 days of initial diagnosis in patients managed non-operatively. Level of evidence Level III

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Beyond the guidelines management of juvenile idiopathic arthritis: a case report of a girl with polyarticular disease refractory to multiple treatment options and Leri Weill syndrome

BMC Pediatrics ◽

10.1186/s12887-021-02494-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Vana Vukić ◽

Ana Smajo ◽

Mandica Vidović ◽

Rudolf Vukojević ◽

Miroslav Harjaček ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Case Report ◽

Treatment Options ◽

Janus Kinase ◽

Musculoskeletal Symptoms ◽

Multiple Treatment ◽

Number Of Patients ◽

Systemic Glucocorticoids ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Background The last two decades brought new treatment options and high quality guidelines into the paediatric rheumatologic practice. Nevertheless, a number of patients still present a diagnostic and therapeutic challenge due to combination of vague symptoms and unresponsiveness to available treatment modalities. Case presentation We report a case of sixteen years old girl suffering from polyarticular type of juvenile idiopathic arthritis refractory to multiple treatment options. She first presented at the age of 4 with swelling and contractures of both knees. Her symptoms were initially unresponsive to nonsteroidal anti-inflammatory drugs and progressed despite treatment with intraarticular and systemic glucocorticoids and methotrexate. Throughout the years, she received several biologics together with continuous administration of nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs as well as intraarticular and systemic glucocorticoids in disease flares. However, none of this options provided a permanent remission, so various other modalities, as well as other possible diagnoses were constantly being considered. Eventually she became dependent on a daily dose of systemic glucocorticoids. In 2018, the treatment with Janus kinase inhibitor tofacitinib was initiated, which led to gradual amelioration of musculoskeletal symptoms, improvement of inflammatory markers and overall well-being, as well as to the weaning of systemic glucocorticoids. As the swelling of the wrists subsided for the first time in many years, Madelung’s deformity was noticed, first clinically, and later radiographically as well. Genetic analysis revealed short-stature homeobox gene deficiency and confirmed the diagnosis of Leri Weill syndrome. Conclusions This case report emphasizes the need for reporting refractory, complicated cases from everyday clinical practice in order to build-up the overall knowledge and share experience which is complementary to available guidelines. Individual reports of difficult to treat cases, especially when additional diagnoses are involved, can be helpful for physicians treating patients with common rheumatological diseases such as juvenile idiopathic arthritis.

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Long-term use of nonsteroidal anti-inflammatory drugs for pain control in patients with osteoarthritis: results of the 12-month observational study AELITA (Analgesia: Effective Treatment Using The Therapeutic Algorithm)

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-6-84-90 ◽

2021 ◽

Vol 15 (6) ◽

pp. 84-90

Author(s):

A. E. Karateev ◽

E. Yu. Polishchuk ◽

E. S. Filatova ◽

A. S. Potapova ◽

V. A. Nesterenko ◽

...

Keyword(s):

Pain Control ◽

Rating Scale ◽

Health Assessment ◽

Pain Reduction ◽

Time Frame ◽

Number Of Patients ◽

Primary Means ◽

Inflammatory Drugs ◽

Anti Inflammatory

Non-steroidal anti-inflammatory drugs (NSAIDs) are the primary means of managing chronic osteoarthritis (OA) pain. The choice of NSAIDs is based on an analysis of the risk of adverse reactions (ARs). Objective: to evaluate the efficacy and safety of long-term use of NSAIDs for pain control in patients with OA in real clinical practice.Patients and methods. To assess the results of long-term use of NSAIDs in OA, a 12-month observational non-interventional study was conducted. It included 611 patients with knee, hip and generalized OA, and nonspecific back pain associated with OA of the facet joints. All patients were prescribed aceclofenac (Aertal®) 200 mg/day. The patients' condition was assessed 2 weeks, 3, 6, 9 and 12 months after the start of therapy. The following parameters were determined: the intensity of pain during movement and the general health assessment (GA) according to the visual analogue scale (VAS, 10 cm); pain intensity according to the Likert verbal rating scale (VRS) (0–4); the number of patients with a pain reduction of ≥50% from baseline; patients' assessment of the result of therapy according to Likert VRS (1–5). The development of ARs was recorded at each visit.Results and discussion. By month 12, 46.8% of patients had dropped out of observation. In patients who continued the study, the average severity of pain according to the VAS at baseline, after 2 weeks, 3, 6, 9 and 12 months was: 6.5±1.2; 4.8±1.4; 3.2±1.4; 2.6±1.4; 2.2±1.1; 1.4±1.1 cm, respectively (significant differences compared to the baseline for all points – p<0.05). The same differences were obtained in GA assessment.Within the indicated time frame, the number of patients with moderate / severe pain (on the Likert scale) decreased from 77.8 to 24.9; 2.9; 2.3; 0.9 and 0%, respectively. The number of patients with a pain reduction of ≥50% from baseline was 12.0; 65.1; 81.0; 88.5 and 84.0%, respectively. A good or excellent assessment of treatment results after 2 weeks was given by 63.3% of patients, and after 12 months – by 95.6%. ARs were observed in about 30% of patients, mainly mild or moderate dyspepsia (in 11.1–23.3%) and arterial hypertension (in 7.1–10.9%). No serious ARs were registered.Conclusion. Aceclofenac is an effective and relatively safe drug for the long-term management of chronic pain in OA.

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Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti-Inflammatory Medications

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.11.010 ◽

2019 ◽

Vol 35 (12) ◽

pp. e2

Author(s):

Brandon Barnds ◽

Matthew Heenan ◽

Armin Tarakemeh ◽

John Paul Schroeppel ◽

Bryan G. Vopat

Keyword(s):

Delayed Union ◽

Metatarsal Fractures ◽

Anti Inflammatory

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HIT antibody positivity as a predictor for early cancer diagnosis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e22184 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e22184-e22184

Author(s):

Zaid Alirhayim ◽

Herman Dyal ◽

Danielle Heidemann ◽

Cesar Ochoa Perez ◽

Abdulqader Alarhayem ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Common Finding ◽

Chi Square ◽

Early Cancer Diagnosis ◽

Number Of Patients ◽

Antibody Positivity ◽

Time To Detection ◽

And Gender ◽

Chi Square Analysis

e22184 Background: Heparin induced thrombocytopenia (HIT) is known to be caused by the presence of PF 4 antibody. Tumors exert immunomodulatory effects on the host immune response, including development of antibodies. Our aim was to analyze the presence of HIT in cancer patients and determine if HIT Ab is an adverse risk factor in patients with cancer. Methods: Patients with suspected HIT were selected. A case – control study was designed with 1:1 age and gender matched controls. We used chi – square analysis to compare proportions and Cox proportional hazard model to detect various predictors. Time to survival analysis was performed using Kaplan – Meier method. Results: Of 600 patients, 300 (63±15 years, women 48.8%) had a mean 4T pre – probability score of 4 ± 1.6. There were 132 cancers in both groups. 65 of these (49.2%) were in patients with probable HIT. The numbers of carcinomas and sarcomas were not significantly different between the two groups. There were no significant differences between the two groups when comparing the number of cancer diagnoses or the particular types of cancer diagnosed. The mean time to detection of cancer was within 9 ± 23 months for patients with HIT Ab versus 31 ± 54 months in cancer patients without HIT Ab (p <0.0001). In addition, there was a greater number of patients with at least 2 primary cancers among the HIT Ab positive group (p = 0.003). No predictive relationship between the type of cancer and the presence of HIT Ab was found (p >0.05). Patients with advanced cancer (stage 3 or 4) were also more likely to be HIT Ab positive (HR 3.61; 95% CI 1.31 – 10.11, p = 0.013). Cancer patients with HIT Ab were more likely to have venous thromboembolism as compared to cancer patients without HIT Ab (7.7% vs. 4.7, p = 0.0001). Kaplan – Meier’s showed worse mortality for cancer patients with HIT Ab than patients without the HIT Ab (Breslow statistic = 0.04). Conclusions: Among our cohort with suspected HIT, cancer was a common finding. Patients with HIT antibody positivity were more likely to have a new cancer diagnosis within 1 year of a positive result. These patients were also more likely to have thromboembolic complications and worsened mortality. These findings require further study, but perhaps suggest that the presence of HIT Ab should trigger earlier surveillance for cancer.

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HUBUNGAN PENGGUNAAN KONTRASEPSI DENGAN KEJADIAN KEHAMILAN EKTOPIK TERGANGGU DI BLU RSUP PROF. DR. R. D. KANDOU MANADO PERIODE 2009 – 2013

e-CliniC ◽

10.35790/ecl.2.3.2014.5758 ◽

2014 ◽

Vol 2 (3) ◽

Author(s):

Deanette M. R. Aling ◽

Juneke J. Kaeng ◽

John Wantania

Keyword(s):

Ectopic Pregnancy ◽

Developed Countries ◽

Social Medicine ◽

Obstetrics And Gynecology ◽

Contraceptive Methods ◽

Chi Square ◽

Number Of Patients ◽

Prior Use ◽

Ectopic Pregnancies ◽

Chi Square Analysis

Abstract: Ectopic pregnancy accounts for 1 in 200 (5-6%) maternal mortality in developed countries.2 According to the WHO, with over 60 000 annual cases in Indonesia– that is 3% of its population, the number of ectopic pregnancies in Indonesia is estimated to be on the brink to cases in developed countries.6 A risk factor for ectopic pregnancy that has surged over the years is the use of contraceptive methods. According to the research at the Department of Epidemiology and Social Medicine University of Brussels in the 90s and two consecutive research the at the Department of Obstetrics and Gynecology BLU RSUP Prof. dr. R. D. Kandou Manado in 2001 and 2011, the use of contraceptive methods have proven to have significant correlation with the incidence of ectopic pregnancy (p>0.05).5,10The issues above are what underlie the aim of this research – that is to investigate the possibility for ectopic pregnancies to occur in patients diagnosed with ectopic pregnancy with prior use of contraceptive methods at the Department of Obstetrics and Gynecology BLU RSUP Prof. dr. R. D. Kandou Manado from October 2009 – October 2013. The method applied for this research is by performing a 5 year retrospective study - analyzing the number of patients with ectopic pregnancy as well as those with prior use of contraceptive methods. The result from a Chi-Square analysis is p = 0.457, where if p < 0.05, means there is a significant correlation. Thus with such result, it is proven that there is no significant correlation between the use of contraceptive methods with the incidence of ectopic pregnancy. Keywords: ectopic pregnancy, contraceptive methods. Abstrak: Kehamilan Ektopik Terganggu (KET) merupakan penyebab 1 dari 200 (5-6%) mortalitas maternal di negara maju.2 Dengan 60.000 kasus setiap tahun atau 3% dari populasi masyarakat, angka kejadian KET di Indonesia diperkirakan tidak jauh berbeda dengan negara maju, menurut WHO.6 Adapun salah satu faktor risiko KET yang dinilai semakin meningkat dewasa ini adalah pemakaian alat-alat/ metode kontrasepsi. Ditinjau dari penelitian di Department of Epidemiology and Social Medicine University of Brussels pada tahun 90an dan penelitian di BLU RSUP Prof. dr. R. D. Kandou Manado pada tahun 2001 dan 2011, pemakaian alat kontrasepsi dengan kejadian KET memiliki hubungan yang signifikan, dengan p > 0.05. Masalah tersebut yang menjadi dasar tujuan penelitian ini, yaitu untuk menindaklanjuti kemungkinan terjadinya KET pada pasien-pasien KET dengan riwayat pemakaian kontrasepsi, dengan memberikan gambaran mengenai data-data kasus KET dengan riwayat penggunaan kontrasepsi yang diperiksa di bagian Obstetri dan Ginekologi BLU RSUP Prof. dr. R. D. Kandou Manado periode Oktober 2009 – Oktober 2013.Metode yang digunakan pada penelitian ini adalah dengan melakukan studi retrospektif, yaitu dengan melakukan pendataan jumlah pasien KET, serta riwayat penggunaan kontrasepsi oleh pasien-pasien KET tersebut dalam kurun waktu 5 tahun. Hasil yang ditemukan memperlihatkan hasil uji Chi-Square adalah p = 0.457, dimana jika nilai p < 0.05, maka dikatakan terdapat hubungan yang signifikan. Oleh karena nilai p pada uji Chi-Square di tabel 4.4.A >0.05, maka dapat dikatakan bahwa tidak terdapat hubungan yang signifikan antara riwayat penggunaan kontrasepsi dengan kejadian KET. Kata kunci: KET (Kehamilan Ektopik Terganggu), kontrasepsi.

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Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial

Circulation ◽

10.1161/circulationaha.119.041296 ◽

2020 ◽

Vol 141 (1) ◽

pp. 10-20 ◽

Cited By ~ 3

Author(s):

Frederik Dalgaard ◽

Hillary Mulder ◽

Daniel M. Wojdyla ◽

Renato D. Lopes ◽

Claes Held ◽

...

Keyword(s):

Atrial Fibrillation ◽

Gastrointestinal Bleeding ◽

Major Bleeding ◽

Oral Anticoagulants ◽

Clinical Trial Registration ◽

Risk Of Bleeding ◽

Number Of Patients ◽

Increased Risk ◽

Inflammatory Drugs ◽

Anti Inflammatory

Background: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) with oral anticoagulants has been associated with an increased risk of bleeding. We investigated the risk of bleeding and major cardiovascular outcomes in patients with atrial fibrillation taking NSAIDs and apixaban or warfarin. Methods: The ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; n=18 201) compared apixaban with warfarin in patients with atrial fibrillation at an increased risk of stroke. Patients in ARISTOTLE without severe renal (creatine clearance ≤30 mL/min) or liver disease were included in this analysis (n=17 423). NSAID use at baseline, NSAID use during the trial (incident NSAID use), and never users were described. The primary outcome was major bleeding. Secondary outcomes included clinically relevant nonmajor bleeding, gastrointestinal bleeding, heart failure hospitalization, stroke or systemic embolism, and all-cause mortality. NSAID use during the trial, and the interaction between randomized treatment, was analyzed using time-dependent Cox proportional hazards models. Results: Those with baseline NSAID use (n=832 [4.8%]), incident NSAID use (n=2185 [13.2%]), and never users were similar in median age (age [25th, 75th]; 70 [64, 77] versus 70 [63, 75] versus 70 [62, 76]). Those with NSAID use at baseline and incident NSAID use were more likely to have a history of bleeding than never users (24.5% versus 21.0% versus 15.6%, respectively). During a median follow-up (25th, 75th) of 1.8 (1.4, 2.3) years and when excluding those taking NSAID at baseline, we found that incident NSAID use was associated with an increased risk of major bleeding (hazard ratio [HR], 1.61 [95% CI, 1.11–2.33]) and clinically relevant nonmajor bleeding (HR, 1.70 [95% CI, 1.16–2.48]), but not gastrointestinal bleeding. No significant interaction was observed between NSAID use and randomized treatment for any outcome. Conclusions: A substantial number of patients in the ARISTOTLE trial took NSAIDs. Incident NSAID use was associated with major and clinically relevant nonmajor bleeding, but not with gastrointestinal bleeding. The safety and efficacy of apixaban versus warfarin appeared not significantly to be altered by NSAID use. This study warrants more investigation of the effect of NSAIDs on the outcomes of patients treated with apixaban. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00412984.

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Localized and targeted delivery of NSAIDs for treatment of inflammation: A review

Experimental Biology and Medicine ◽

10.1177/1535370218787770 ◽

2018 ◽

Vol 244 (6) ◽

pp. 433-444 ◽

Cited By ~ 16

Author(s):

Rebecca M Haley ◽

Horst A von Recum

Keyword(s):

Drug Delivery ◽

Side Effects ◽

Targeted Delivery ◽

Local Drug Delivery ◽

Future Research ◽

Systemic Delivery ◽

Number Of Patients ◽

Long Term Treatment ◽

Inflammatory Drugs ◽

Anti Inflammatory

Inflammatory processes are increasingly being identified at the core of many different disease states (e.g. heart disease, cancer, diabetes). As such, anti-inflammatory strategies available through drug delivery have undergone renewed interest. Due to the systemic side effects of steroidal drugs, non-steroidal anti-inflammatory drugs are often preferred for long-term treatment of inflammation in a variety of applications. While non-steroidal anti-inflammatory drugs are generally safe, there are some serious side effects that can be associated with their usage, particularly when given systemically or orally. Due to the high number of patients taking non-steroidal anti-inflammatory drugs, the reduction or elimination of these side effects, such as is possible through local drug delivery, could have a very powerful effect on patient quality of life. This review comments on a sampling of existing methods for localized or targeted delivery of non-steroidal anti-inflammatory drugs, with the goal of helping future research groups to focus on bettering methods shown to be effective and filling the gaps of knowledge in this field. Additionally, commentary is made on the field as a whole, and the standardization issues that arise from its expansiveness and diversity. Impact statement This work provides an overview of research currently being done exploring potential drug delivery device strategies for NSAIDs as an alternative to systemic delivery. Commentary on this field is made in an attempt to aid future experimental design, enabling researchers to determine the drugs and delivery vehicles which are most advantageous for them to pursue, as well as suggestions to standardize the reporting of such future research.

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Effect of Premedication with Anti-inflammatory Drugs on Post-Endodontic Pain: A Randomized Clinical Trial

Brazilian Dental Journal ◽

10.1590/0103-6440201801786 ◽

2018 ◽

Vol 29 (3) ◽

pp. 254-260 ◽

Cited By ~ 1

Author(s):

Adrian Camargo Amaral Jorge-Araújo ◽

Marcelo Carlos Bortoluzzi ◽

Flares Baratto-Filho ◽

Fábio André Santos ◽

Márcia Thaís Pochapski

Keyword(s):

Pain Intensity ◽

Rescue Medication ◽

Rating Scale ◽

Numerical Rating Scale ◽

Secondary Outcome ◽

Chi Square ◽

Significant Difference ◽

Numerical Rating ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract In spite of advances in root canal therapy and better knowledge of pulpal and periapical inflammation, up 40% of endodontic patients report varying degrees of pain. The aim of this present study was to compare the effect of single preoperative dose of ibuprofen or dexamethasone on post-endodontic pain. Sixty volunteers were divided into three groups (n=20 per group): PL, placebo; IB, 400 mg of ibuprofen; and DE, 8 mg of dexamethasone. The primary outcome was the post-endodontic pain intensity measured with a numerical rating scale (4, 8, 12, 24, and 48 h). Secondary outcomes included number of anesthetic cartridges used and consumption of rescue medication. Data were analyzed by one-way ANOVA, chi-square and Kruskal-Wallis tests. There was no significant difference among groups (p>0.05) considering the pain intensity. Only 37% of IB group patients and 28% of DE group patients used some rescue medication. On the other hand, 74% of PL group patients mentioned the consumption of rescue medication; PL group had a statistically significant difference (p<0.05) in comparison with IB and DE groups. The number of anesthetic cartridges used had no statistically significant difference among the groups (p>0.05). Significant differences were not found in the reduction of pain intensity and the number of anesthetic cartridges used. Considering the consumption of rescue medication (secondary outcome), preoperative administration of Ibuprofen or dexamethasone reduces post-endodontic pain and discomfort in comparison with a placebo. Premedication with anti-inflammatory drugs drugs could be contributed to control of the post-endodontic pain, mainly in patients more sensible for pain.

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