Combination of etodolac and dexamethasone improves preemptive analgesia in third molar surgery: a randomized study
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ORIGINAL ARTICLE
Combination of etodolac and dexamethasone improves preemptive analgesia in third molar surgery: a randomized study Guilherme André D. Ramires 1 & Anderson Maikon de Souza Santos 1 & Gustavo A. C. Momesso 1 & Tárik Ocon B. Polo 1 & William P. P. Silva 1 & Stéfany Barbosa 1 & Ana Paula F. Bassi 1 & Leonardo Perez Faverani 1 Received: 20 July 2020 / Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective This randomized, controlled, triple-blind, crossover clinical trial aimed to investigate the use of dexamethasone (DEX) and etodolac (ETO) as preemptive analgesia before mandibular third molar extraction. Methods Patients were divided into three groups (n = 20 teeth each) based on the drug administered: DEX 8 mg (DEX); DEX 8 mg plus ETO 300 mg (DEX + ETO), and ETO 300 mg (ETO). Paracetamol (750 mg) tablets were administered as rescue analgesics. Pain was evaluated using the visual analog scale (VAS) at 6, 12, 24, 48, and 72 h and 7 days postoperatively. Edema and trismus were assessed 48 and 72 h postoperatively. All data were subjected to statistical analysis, where a P value < .05 indicated statistical significance. Results VAS scores and the number of rescue analgesics taken were lower in the DEX + ETO group than in the other groups (P < .001 and P = .014, respectively). At 48 h, trismus was similar among all groups; however, the ETO group showed the highest trismus 7 days postoperatively (P < .05). Edema was similar among all groups at all time points (P > .05). Conclusion The combined use of the anti-inflammatory drugs, DEX and ETO, resulted in better pain control and the need for fewer rescue analgesics than the use of either drug alone, which indicated their effectiveness in mandibular third molar extractions preoperatively. Clinical relevance This drug combination can lead to less pain, edema, and trismus and reduce the use of rescue analgesics in the postoperative period. Keywords Third molar . Edema . Analgesia . Anti-inflammatory agents
Introduction Pain prevention was first introduced in clinical practice by Crile in 1913 and was later developed by Wall [1] and Woolf and Chong [2]. Experimental observations have demonstrated that analgesics and anti-inflammatory drugs are more effective if administered before the noxious stimulus and not just after tissue injury, as mentioned by Woolf and Chong [2]: Simple changes in the timing of therapeutic intervention can have profound and beneficial effects on postoperative pain. Subsequently, these promising experimental * Leonardo Perez Faverani [email protected] 1
Department of Diagnosis and Surgery, Sao Paulo State University (UNESP), School of Dentistry, Aracatuba, 1193 Jose Bonifacio St, Aracatuba, São Paulo 16015-050, Brazil
results have been used as the basis for some randomized clinical trials of preemptive analgesia using dexamethasone (DEX) [3] and non-steroidal anti-inflammatory drugs (NSAIDs) [4]. Preemptive analgesia involves the administration of medications prior to nocicep
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