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1. ANALGIC EFFICACY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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Pain resulting from surgical removal of third
molars is a frequent problem and may effect
patient’s postoperative quality of life.
Pain reaches max intensity within 3-5 hrs of
surgery.
NSAID’S inhibit the synthesis of PG’S and
reduce inflammatory reaction and nociceptive
stimuli and thus contribute to pain control.
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Aceclofenac frequently used in medical practice
to control rheumatic pain.
Aceclofenac has anti-inflammatory properties
similar to diclofenac and indomethacin and
yields good results in control of dental pain.
The peak of plasma concentration brtween 1h
25min and 3h, so the recommended dosage is 200
mg/day
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Forty patients, twenty six female and fourteen
male, age 18-35 years( mean 23 yrs).
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Inclusion criteria were surgical procedure
requiring osteotomy and/or tooth sectioning.
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Exclusion criteria:- for female pts, not pregnant
or breastfeeding, other exclusion criteria were no
known sensitivity to NSAID, no reported use of
other nsaid, psychotropic drugs or chronic med,
no ho blood dyscrasias or immunosupresion.
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Patients divided into two groups:group 1- 20 pts medicated with 2 tablets of 100mg
aceclofenac taken orally 1 hr before surgery
group 2- 20 pts medicated with 2 tablets of 100mg
aceclofenac taken orally in the early postoperative
period.
SURGICAL TECH:- anaesthetic block of alveolar,
mandibular, lingual and buccal nerves with 2%
mepavacain chloride with adrenaline 1:100,000.
Mucoperiosteal incision in the retromolar trigone,
with a relaxing vestibular incision In the mesial
aspect of second molar and raising a mp flap.
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Osteotomy with a rotary 702 bur and 0.9%saline
irrigation, and tooth sectioning when indicated is
done with 151 zekaria bur 28mm. Tooth elevated
with straight and offset elevators and suturing done
with monofilamentous nylon simple interrupted
suture.
Analgesic escape med was two 500mg paracetmol
tabs administered every 6h in both groups.
The assessment of pain sensitivity was conducted
with two scales, a visual analogue scale and a 0-4
scale, used by the pts at 2,4,6,12 and 24h after
surgery
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VAS SCALE:- the difference in the post op pain
scores between the two groups was not
significant at any of the time points.
although pts in group 1 had a lower pain score
at all points. Mean pain score in both groups
was never greater than 2.5
0-4 SCALE:-at 6h after surgery, the difference
between the groups was signifinicant. This diff is
observed in both scales.
The results of the t test showed that the efficacy
of nsaids was greater in group 1
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POST-OP pain resulting surgery of impacted
mand third molars is one of the most frequent
complications. Pain is moderate to severe and
likely to affect the patients routine.
Pain is subjective and experienced differently by
each individual. Therefore only patients are able
to assess the pain that they are feeling. In this
study the parameters used to assess pain
intensity were visual analogue scale and 0-4
scale.
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Results found in the vas showed that group 1
had a lower pain score at all time points in the
study.
In both groups, a 200mg NSAID dose was
efficient in controlling pain, with mean vas
score below 2.5.
Mean pain score for group 1in the first 6h after
surgery, the critical pain period, was lower in
both the scales.
These results show that NSAIDS are more
efficient in controlling pain when administered
before the onset of inflammatory process.
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The criteria that we adopted to determine the study
time points were based on literature reports that
indicate the greatest pain is experienced in the 3-6h
period after surgery.
In the present study the currently recommended max
daily dose, 200mg was used.
The use of a control placebo group would be ideal to
evaluate the efficacy of the current drug studied here.
Our results showed that, considering the first 6
postop hours, aceclofenac was more efficient in
controlling pain resulting from surgery of impacted
mand third molars when administered before
surgery.
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14. Thank you
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Leader in continuing dental education
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