Study on the Outcome of Preoperative Administration of Single-Dose Ketorolac, Ibuprofen 400mg and Placebo on Postoperative Pain in Teeth with Irreversible Pulpitis and Apical Periodontitis

Background Dexamethasone is frequently administered in the perioperative period to reduce postoperative nausea and vomiting. In contrast, the analgesic effects of dexamethasone are not well defined. The authors performed a meta-analysis to evaluate the dose-dependent analgesic effects of perioperative dexamethasone. Methods We followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose systemic dexamethasone on postoperative pain and opioid consumption. Meta-analysis was performed using a random-effect model. Effects of dexamethasone dose were evaluated by pooling studies into three dosage groups: low (less than 0.1 mg/kg), intermediate (0.11-0.2 mg/kg) and high (≥ 0.21 mg/kg). Results Twenty-four randomized clinical trials with 2,751 subjects were included. The mean (95% CI) combined effects favored dexamethasone over placebo for pain at rest (≤ 4 h, -0.32 [0.47 to -0.18], 24 h, -0.49 [-0.67 to -0.31]) and with movement (≤ 4 h, -0.64 [-0.86 to -0.41], 24 h, -0.47 [-0.71 to -0.24]). Opioid consumption was decreased to a similar extent with moderate -0.82 (-1.30 to -0.42) and high -0.85 (-1.24 to -0.46) dexamethasone, but not decreased with low-dose dexamethasone -0.18 (-0.39-0.03). No increase in analgesic effectiveness or reduction in opioid use could be demonstrated between the high- and intermediate-dose dexamethasone. Preoperative administration of dexamethasone appears to produce a more consistent analgesic effect compared with intraoperative administration. Conclusion Dexamethasone at doses more than 0.1 mg/kg is an effective adjunct in multimodal strategies to reduce postoperative pain and opioid consumption after surgery. The preoperative administration of the drug produces less variation of effects on pain outcomes.

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Effect of Occlusal Reduction on Postoperative Pain After Endodontic Treatment in Teeth with Irreversible pulpitis and Symptomatic Apical Periodontitis: A Randomized Clinical Trial

Acta Scientific Dental Scienecs ◽

10.31080/asds.2021.05.1186 ◽

2021 ◽

pp. 46-54

Author(s):

Marian Shenoda Fathy ◽

Hebatallah Mohamed Maged ELFar ◽

Shaimaa Ismail Gawdat

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Irreversible Pulpitis

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Effect of a single dose of preoperative gabapentin in oncourology on the intensity of early postoperative pain

Pain medicine ◽

10.31636/pmjua.v5i4.3 ◽

2021 ◽

Vol 5 (4) ◽

pp. 16-21

Author(s):

I I Lisnyy ◽

L V Klimchuk

Keyword(s):

Single Dose ◽

Postoperative Pain ◽

Pain Relief ◽

Pain Syndrome ◽

Surgical Interventions ◽

Preoperative Administration ◽

Group 2 ◽

Pain At Rest ◽

Group 1

Objective: to evaluate the intensity of early postoperative pain after a single preoperative administration of gabapentin during surgical interventions in oncourology. Materials and methods: patients were randomized into two groups of 25 people each: group 1 (Gr. 1) received gabapentin at a dose of 300 mg for premedication at night, and group 2 (Gr. 2), in which patients did not receive gabapentin. The need for propofol during anesthesia, the need for fentanyl during anesthesia, and the intensity of pain at 2, 4, 6, 12 and 24 hours after surgery were assessed on the VAS scale at rest and during movement. Results of the study: it was shown that in patients who received gabapentin at a dose of 300 mg for premedication, the need for propofol and fentanyl was significantly lower when compared with patients who did not receive gabapentin, p = 0.0001. The intensity of postoperative pain syndrome in patients in Gr. 1 was significantly lower only when assessed at rest, while no statistically significant differences were found in the quality of pain relief during movement. Conclusions: the use of gabapentin at a dose of 300 mg for premedication significantly reduces the intensity of postoperative pain at rest, but not during movement, and also reduces the need for propofol and fentanyl during surgery.

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An Evaluation of Ibuprofen Versus Ibuprofen/Acetaminophen for Postoperative Endodontic Pain in Patients With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis

Anesthesia Progress ◽

10.2344/anpr-66-03-06 ◽

2019 ◽

Vol 66 (4) ◽

pp. 192-201

Author(s):

Alex Stamos ◽

Melissa Drum ◽

Al Reader ◽

John Nusstein ◽

Sara Fowler ◽

...

Keyword(s):

Postoperative Pain ◽

Severe Pain ◽

Medication Use ◽

Apical Periodontitis ◽

Postoperative Pain Control ◽

Pain Ratings ◽

Patient Model ◽

To Receive ◽

Pain Patients ◽

Irreversible Pulpitis

The purpose of this investigation was to compare ibuprofen versus an ibuprofen/acetaminophen combination for postoperative pain control in a patient model specific to teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. One hundred and two patients presenting with moderate to severe pain from a maxillary or mandibular posterior tooth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis were included. Following local anesthetic administration, complete endodontic cleaning and shaping was performed. Patients were randomly assigned to receive identically appearing tablets of ibuprofen 200 mg or a combination of ibuprofen 200 mg/acetaminophen 216.7 mg with instructions to take 3 tablets every 6 hours as needed for pain. Patients were also given a prescription for an escape medication to take if the study medications did not adequately control their pain. A 4-day diary was used to record pain ratings and medication use. Moderate to severe pain was experienced by 59–61% of the patients on postoperative day 1 and 50–57% of the patients on day 2, with the pain ratings decreasing over the next 2 days. There were no statistically significant differences between the 2 groups in postoperative pain, percussion pain, or medication use. There was no difference between ibuprofen and the combination of ibuprofen/acetaminophen in the reduction of postoperative pain following endodontic debridement in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

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