Efficacy of Pre-Operative Submucosal Injection of Dexamethasone in Mandibular Third Molar Surgery: A Randomized Control Trial

INTRODUCTION: Surgical extraction of third molar irrespective of any technique results in postoperative pain, swelling of face and limited mouth opening. The aim of the present study was to assess and compare the effects of Dexamethasone (4mg) administered prior to surgery.MATERIALS AND METHOD: A randomized control trial was conducted which included a total of fifty patients. All the patients were randomly put in two groups of twenty five each. Group I patients underwent transalveolar extraction of third molar under local anesthesia and standard oral drug regime. Group II patients received an additional submucosal injection of dexamethasone 4 mg, thirty minutes prior administration of local anaesthesia. Pain, swelling and mouth opening was recorded on second, seventh and tenth post-operative days after surgery.RESULTS: The difference in pain scores on second post-operative day between two groups were found statistically non-significant. However, there was significant reduction in pain scores on seventh and tenth day in both groups. Mouth opening showed statistically significant difference between the two groups.CONCLUSION: The observations of the present study provide a fundamental basis for the use of corticosteroids such as dexamethasone sodium phosphate in the form of submucosal administration in lower than usual doses to decrease postoperative inflammation when compare to other routes of drug administration.

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73 The Use of Topical Anaesthetic in The Banding of Internal Haemorrhoids: A Feasibility Study for A Randomized Control Trial

British Journal of Surgery ◽

10.1093/bjs/znab258.038 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

V Sharma ◽

D Sharma ◽

A Stearns ◽

J Hernon

Keyword(s):

Outcome Measures ◽

Randomized Control Trial ◽

Recruitment Rate ◽

Phase Iii ◽

Feasibility Trial ◽

Secondary Outcome ◽

Topical Anaesthetic ◽

Pain Scores ◽

Significant Difference ◽

Randomized Control

Abstract Aim Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. 90% of patients experience pain following RBL. We aimed to complete a feasibility randomized control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids. Method We performed a prospective, single-centre, single blinded, randomized(1:1) controlled feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomized to undergo the procedure with local anaesthetic or without(control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30minutes, 4 hours, and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate, patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia, and adverse outcomes. Results 35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. 33(94%) participants remained in the study until completion, with 2 patients lost to telephone follow-up. The treatment was acceptable for 35(97%) eligible patients. 1 patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2(95% CI -4.0 to -1.0, p = 0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms(p = 0.10) or new analgesia use(p = 0.85). Conclusions In conclusion, we have shown that a phase III clinical trial is feasible. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.

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Perbandingan Efektivitas Anestesi Spinal dengan Bupivacain 12,5 Mg dan Bupivacain 5 Mg yang ditambah Fentanyl 50 Mcg pada Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v4i1.55 ◽

2021 ◽

Vol 4 (1) ◽

pp. 11-7

Author(s):

Fritzky Indradata ◽

Heri Dwi Purnomo ◽

Muh. Husni Thamrin ◽

Sugeng Budi Santoso ◽

Ardana Tri Arianto ◽

...

Keyword(s):

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Randomized Control Trial ◽

Hyperbaric Bupivacaine ◽

Chi Square ◽

Double Blind ◽

Duration Of Action ◽

Significant Difference ◽

Randomized Control

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

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Effects of thoracic spine manipulation on pressure pain sensitivity of rhomboid muscle active trigger points: a randomized control trial

Journal of the Pakistan Medical Association ◽

10.47391/jpma.02-256 ◽

2021 ◽

pp. 1-12

Author(s):

Bibi Haleema ◽

Huma Riaz

Keyword(s):

Thoracic Spine ◽

Randomized Control Trial ◽

Rating Scale ◽

Trigger Points ◽

Control Group ◽

Pressure Sensitivity ◽

Myofascial Trigger Points ◽

Pain Pressure Threshold ◽

Significant Difference ◽

Randomized Control

Abstract Objective: The objective of study was to determine the effects of thoracic spine manipulation on interscapular pain and pain pressure sensitivity, thoracic mobility and disability due to active myofascial trigger points in rhomboid muscle. Methods: A randomized control trial was conducted at Women Institute of Rehabilitation Sciences Abbottabad, from July to December 2019.Ethical permission was taken fromResearch ethical committee of Riphah international university Islamabad. Participants were selected through non-probability purposive sampling technique as per inclusion criteria. It consisted of 60 participants with forward head posture having active trigger points in rhomboid muscle, with age ranging from 18 to 30 years. The participants were randomly allocated through sealed envelope method into two groups that are experimental and control. Experimental group has received thoracic manipulation along with conventional physical therapy (CPT) whereas control group has only received CPT including manual pressure release and therapeutic exercise. Intervention was applied with 2 sessions / week with 3 weeks in total. Pre and Post assessment was done with outcome measurement tools comprised of Numeric pain rating scale (NPRS) for pain severity, Algometry for pain pressure threshold(PPT), Inclinometer for Range of movement(ROM) and Neck disability index (NDI) for associated disability. Data analysis was done using SPSS-20 version. Results: Between group analysis has shown significant improvement of pain & pain pressure sensitivity with p value <0.01 and <0.05 respectively. All outcome measures have shown significant difference in pre post treatment (p<.000) in both groups. Continuous...

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B Lynch Suture and Intrauteribne Balloon Tamponade for Management of Severe Postpartum Hemorrhage: A Comparative Study

10.53350/pjmhs211592948 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2948-2951

Author(s):

Mehwish Syed ◽

Afrah Aman ◽

Saeeda Safi ◽

Rabia Nawaz ◽

Asia Habib ◽

...

Keyword(s):

Success Rate ◽

Gestational Age ◽

Postpartum Hemorrhage ◽

Randomized Control Trial ◽

P Value ◽

Bleeding Control ◽

Balloon Tamponade ◽

Group I ◽

Randomized Control ◽

Group Ii

Objective: The aim of this study is to compare the effectiveness of intrauterine balloon tamponade and B lynch suture for management of severe postpartum hemorrhage. Study Design: Randomized Control trial Place and Duration: The study was conducted at Gynae & Obs department of Qazi Hussain Ahmad Medical Complex, Nowshera KPK for six months duration from January to 2021 to June 2021. Methods: There were one hundred and twenty patients with ages 20-45 years were presented in this study. All women had severe postpartum hemorrhage were included in this study. Demographically detailed of enrolled cases age, body mass index, gestational age and parity were recorded after taking informed written consent. Patients were equally divided into 2-groups I and II. Group I had 60 patients and received Lynch suture while in group II 60 patients received intrauterine balloon tamponade. Post-operative success rate among both groups were assessed and compared in terms of bleeding control within 10-15 minutes. SPSS 24.0 version was used to analyze the complete data. Results: In group I mean age was 29.09±2.53 years with mean BMI 25.11±7.64 kg/m2 while in group II mean age was 29.02±3.62 years with mean BMI 24.87±6.32 kg/m2. Mean gestational age in group I was 37.87±3.29 weeks and in group II mean gestational age was 38.19±6.41 weeks. Mean parity in group I was 4.03±1.19 and in group II it was 4.01±0.87. Frequency of success rate in group I was significantly higher among 54 (90%) cases as compared to group II 39 (65%) with p value < 0.05. We found that patients of group I was significantly satisfied than that of patients who received intrauterine balloon tamponade. Conclusion: In this research we concluded that lynch suture for the management of severe postpartum hemorrhage among females had higher effectiveness in terms of bleeding control within 15 minutes and with higher satisfaction among patients as compared to those females who received intrauterine balloon tamponade. Keywords: Postpartum hemorrhage, Lynch Suture, intrauterine balloon tamponade, Success Rate

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Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

International Journal of Dentistry ◽

10.1155/2017/1350375 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Hashem M. Al-Shamiri ◽

Maha Shawky ◽

Nermin Hassanein

Keyword(s):

Postoperative Complications ◽

Third Molar ◽

Mouth Opening ◽

Comparative Assessment ◽

Third Molar Surgery ◽

Oral Dexamethasone ◽

Preoperative Administration ◽

Surgical Extraction ◽

The Face ◽

Postoperative Administration

Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery.Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper.Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002).Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

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Comparison of analgesic efficacy between TAP block and local site infiltration post operatively in caesarean section

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181305 ◽

2018 ◽

Vol 6 (4) ◽

pp. 1407 ◽

Cited By ~ 2

Author(s):

Nabanita Das ◽

Usha Shukla ◽

Dheer Singh ◽

Urvashi Yadav

Keyword(s):

Caesarean Section ◽

Postoperative Analgesia ◽

Analgesic Efficacy ◽

Tap Block ◽

Local Site ◽

Pain Scores ◽

Group I ◽

Significant Difference ◽

Patient Pain ◽

Study Population

Background: Patients undergoing caesarean section need to be alert, comfortable and mobile in order to take care of their babies, for which they must be pain free in post operative period. The aim of present study is to compare the analgesic efficacy of TAP block with local anaesthetic infiltration specifically in LSCS patients in reducing patient pain postoperatively, as well as to decrease the analgesic requirements.Methods: The study population consisted of 60 patients posted for elective and emergency caesarean section. They were blindly divided into two groups of 30 patients each. Group T received 40ml 0.25% Ropivacaine in Transverses abdominis plane (TAP) block for postoperative analgesia and group I received 40ml 0.25% ropivacaine as infiltration at incision site for postoperative analgesia. Patients were observed for numeric pain score NPS, analgesic requirements, total analgesic consumption and adverse effects if any.Results: There was highly significant difference in numeric pain scores at 2nd, 6th, 12th and 24th hours (p<0.0001). Both the time for first rescue analgesic and total amount of analgesic consumed are statistically significant (p<0.0001).Conclusions: TAP block is an effective postoperative analgesic procedure for post caesarean section patients.

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TO COMPARE THE EFFECT OF PRE-EMPTIVE DEXAMETHASONE AND METHYLPREDNISOLONE EITHER BY INTRAMUSCULAR OR BY SUBMUCOSAL ROUTE FOR THE POSTOPERATIVE CONTROL OF PAIN, SWELLING, AND LIMITED MOUTH OPENING FOLLOWING THE EXTRACTION OF IMPACTED THIRD MOLARS

10.36106/ijsr/1824575 ◽

2020 ◽

pp. 1-7

Author(s):

Kiran Shubha ◽

Ravi Narula ◽

Navneet Kaur

Keyword(s):

Intramuscular Injection ◽

Third Molar ◽

Mouth Opening ◽

Surgical Removal ◽

Third Molars ◽

Limited Mouth Opening ◽

Submucosal Injection ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars ◽

Better Than

Introduction: The surgical removal of impacted mandibular third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing when exacerbated it may cause pain, swelling and limited mouth opening. Corticosteroids are among the most widely employed pre-operative medication administered for the control of such complications. Objective: To compare the effects of single dose of pre-operative Injection Dexamethasone versus Injection Methylprednisolone via Intramuscular or Submucosal route for controlling the post-operative pain, swelling and limited mouth opening in the removal of impacted mandibular third molars. Material and Method:. The present study was conducted on 40 healthy adult patients with bilaterally symmetrical impacted mandibular third molar, reporting to the Department of oral and Maxillofacial Surgery of Guru Nanak Dev Dental College and Research Institute, Sunam. Clinically, pain, swelling, mouth-opening were evaluated pre-operatively as baseline and post-operatively on 1st, 3rd and 7th post-operative days. Results: The results of our study are summarized below: In Group A: Submucosal injection of dexamethasone gave better results in controlling pain, swelling and trismus in comparison to Intramuscular injection of dexamethasone. In Group B: Submucosal injection of methylprednisolone showed better results in terms of pain, swelling and trismus when compared with Intramuscular injection of methylprednisolone. In Group C: Intramuscular injection of dexamethasone gave better results in terms of pain and mouth opening but, swelling was reduced with Intramuscular methylprednisolone. In Group D: Submucosal injection of dexamethasone showed better results in terms of pain, but swelling and mouth opening was reduced when methylprednisolone was used submucosal. Conclusion: The results of our study concluded that Dexamethasone is better than Methylprednisolone in controlling post-operative sequelae after third molar surgery. This can attributed to the higher potency and longer half-life and less sodium retaining capacity of dexamethasone than methylprednisolone. The results of our study also concluded that submucosal route of administration of drug is better than Intramuscular route because of the repository effect of the submucosal route, also this route is beneficial to the patient as well to the surgeon because needle penetration is done in the pre-anesthetized area, also it is an easy technique to be mastered by the surgeon.

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Flap vs flapless technique for impacted third molar removal: A split mouth prospective randomized control study

Journal of Oral Medicine Oral Surgery Oral Pathology and Oral Radiology ◽

10.18231/j.jooo.2021.051 ◽

2021 ◽

Vol 7 (3) ◽

pp. 167-171

Author(s):

Neeraj ◽

Banshilal Beniwal ◽

Padmanidhi Agarwal ◽

Vikas Berwal ◽

Richa Malik

Keyword(s):

Healing Process ◽

Third Molar ◽

Mouth Opening ◽

Third Molars ◽

Pocket Depth ◽

Second Molar ◽

Group I ◽

Flap Design ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique. Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed. The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap). The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.

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Efficacy of platelet rich plasma (PRP) on mouth opening and pain after surgical extraction of mandibular third molars

Journal of Oral Medicine and Oral Surgery ◽

10.1051/mbcb/2020045 ◽

2020 ◽

Vol 27 (1) ◽

pp. 9

Author(s):

Maidah Hanif ◽

Muhammad Azhar Sheikh

Keyword(s):

Platelet Rich Plasma ◽

Maxillofacial Surgery ◽

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Oral And Maxillofacial Surgery ◽

Surgical Removal ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Molar Teeth

Introduction: Surgery of mandibular third molar teeth for removal is one of the most common procedures undertaken in oral and maxillofacial surgery departments. The complications created by the post extraction wound healing and physiological consecution of third molar surgery can affect patients' quality of life. Platelet rich plasma (PRP) is an autologous concentrate of platelets suspended in the Plasma that accelerates healing by concentration of growth factors which lessen the inflammation and as a result pain and trismus. Materials and methods: A Study was conducted on 130 patients at the department of Oral and Maxillofacial Surgery, FUCD Islamabad, for a period of 6 months after ethical approval. The patients with impacted mandibular wisdom teeth were selected and divided equally into two equal groups. The pain score was measured using the visual analogue scale (VAS) and trismus was measured using Vernier caliper before the surgery, immediately after surgery, on 3rd and 7th follow up visits. Results: The mean postoperative pain on 7th day was significantly lower in the PRP group with statistically significant P-value <0.0001. Trismus was also less reported in the PRP group with P-value <0.00065. Conclusion: Platelet Rich Plasma is effective to lessen trismus and pain after surgical removal of mandibular third molar teeth.

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Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial

BMC Oral Health ◽

10.1186/s12903-021-01759-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wissam Nehme ◽

Youssef Fares ◽

Linda Abou-Abbas

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Third Molar ◽

Mouth Opening ◽

Mean Difference ◽

Third Molar Surgery ◽

Third Molars ◽

Dexamethasone Group ◽

Mandibular Third Molar ◽

Surgical Extraction

Abstract Background Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain. Methods A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7. Results The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001). Conclusion The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery. Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1

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