1. Role of analgesics in
Exodontics
Dr. V.RAMKUMAR
CONSULTANT DENTAL AND FACIOMAXILLARY SURG
REG NO: 4118 TAMILNADU – INDIA ( ASIA)

2.  Analgesics are drugs that selectively relieve
pain by acting on the CNS or on the
peripheral pain mechanisms without
significantly altering consciousness.

3. Classification of analgesics
1…Opiod/Narcotic or morphine like
 Natural (opium)
 Semisynthetic opioids
 Synthetec opiods
 Agonist/Antagonist

4. 2…Non opioid/Non steroidal anti-inflammatory
analgesics and antipyretics
 Potent anti inflammatory and good analgesics
 Potent anti inflammatory and poor or
moderate analgesics
 Moderate anti inflammatory and moderate
analgesecs
 Poor anti inflammatory and good analgesic

5. Opioid analgesics
1. MORPHINE
Morphine acts by –
 Raising pain threshold assisted by euphoria
which it produces
 Modifies emotional reaction to pain
 Induces sleep
it is best avoided in asthmatics.

6. Adverse effects –
 Nausea
 Vomiting
 Respiratory depression
 Histamine release
 Broncho constriction
 Postural hypotension
 Constipation
 Tolerance and dependence

7. Preparation and dose –
 Morphine sulphate 10 mg/ml for i.m. use.
 Preservative free solutions 1 mg/ml are
intended for I.V. use.

8. 2. CODEINE (Sulphate or phosphate)
 30 mgs of codeine is equianalgesic with 600
mgs of aspirin and has a synergistic effect
with aspirin.
 No respiratory depression, no pupillary effects
and less chance of addiction.
 Used along with aspirin as an analgesic.

9. 3. PETHIDINE (Meperidine)
1/10th
as potent as morphine as an analgesic.
Adverse effects –
 Respiratory depression
 Produce mydriasis
 Nausea
 Vomiting
 Hypotension following pethidine
Dose – 50 to 100 mgs i.m. or i.v.
Uses – in severe pain and as a premedication before
anesthesia

10. 4. DEXTROPROPOXYPHENE
As an analgesic, half as potent as codeine.
With aspirin gives a better analgesic effect.
Adverse effects –
 Nausea
 Constipation
 Drowsiness
Dose – 65 mgs of dextropropoxyphene with 40 mgs
aspirin

11. 5. PENTAZOCINE (Fortwin 30 mg/ml or 25 mg tablets)
 30 mgs of pentazocine produces analgesia produced
by 10 mgs of morphine.
 Respiratory depression 1/3 as that produced by
morphine.
 Contraindicated in myocardial infarction and coronary
ischemia.
Adverse effects –
 Sedation
 Nausea
 Sweating and dizziness or light headedness.
Dose- 25 to 100 mgs oral
30 to 60 mgs IM or IV

12. Non opioid analgesics
1.ASPIRIN
 Act as an antipyretic and also produces
cutaneous vasodialatation.
 As an analgesic, weaker than morphine type
drugs
 Best analgesic in a diabetic when carefully
used.
 Best avoided in patients with bleeding
tendencies
 Should not be given to patient on dicoumerol.
 Can cause hypoglycemia.

13. Adverse effects –
 Hypersensitivity
 Nausea
 Vomiting
 Epigastric distress
 GL bleeding

14. ASPIRIN tablets
Microfine particles 300mgs
or soluble aspirin For pain upto 120 mgs daily
with calcium carbonate For rheumatic fever
and citric acid 4 to 8 gram daily
Preparation and dose –

15. 2. PHENACETIN AND PARACETAMOL
 Central analgesic action similar to aspirin
 Weak peripheral anti inflammatory effect and
 Poor inhibitors of prostaglandin synthesis
Adverse effects –
 Drowsiness
 Gastric irritation
 Hepatic necrosis
 Renal tubular necrosis
 Methhemoglobinemia
 Hemolytic anaemia

16. Dose –
 Phenacetin 300 to 600 mgs (oral)
 Paracetamol 500 mgs (oral)
 Daily dose should not exceed 2.5g in adults.
Uses –
As a substitute for aspirin for pain and fever
when aspirin is contraindicated.

17. 3. PHENYLBUTAZONE
Adverse effects –
 Peptic ulcers
 Aplastic anaemia
 Agranulocytosis
Doses-
 Oral – 100 to 200 mgs tds with food
 IM – 600 mgs

18. 4. OXYPHENBUTAZONE
A major active metabolite of phenylbutazone.
Just like phenylbutazone except-
i) Lesser gastric irritation.
ii) More effectively inhibits acute inflammation
like inflammation due to trauma and hence
has a place in minor oral surgery.

19. 5. ANALGIN
A derivative of amidopyrine.
A potent and promptly acting analgesic.
It has a poor anti-inflammatory action.
Dose –
Can be given orally, i.m. or i.v.
i.v. injection can cause a fall in B.P.
Available as tablets of 500 mgs or 2ml injections
containing 300 mgs
Adverse effects –
 Agranulocytosis
 Severe gastric irritation

20. 6. APAZONE
An aspirin like pyranqolon agent with a spectrum of
activity like phenylbutazone but less toxic.
It is anti-inflammatory, antipyretic, analgesic and
uricosuric.
Rapidly absorbed on oral route and has a plasma half
life of about 24 hours.
Dose – 1200 mgs/day

21. 7. IODOMETHACIN
It has both central and peripheral action.
It inhibits motility of neutrophils and hence can be a
disadvantage in diabetics
Adverse effects –
 Gastric irritation
 Diarrheoa
 Dizziness
 Depression
 Neutropenea
 Aplastic anaemia
 Thrombocytopenia
Doses –
25 mgs twice daily

22. 8. SULINDAC
Half as potent as indomethacin but with less
gastric irritation.
It can precipitate a severe reaction in patients
sensitive to aspirin
Doses –
150mgs twice daily (oral)

23. Propionic acid derivatives
Have the following properties but vary in potency –
i) Analgesic, antipyretic and anti inflammatory efficacy
is rated somewhat lower than a high dose of
aspirin.
ii) All inhibit prostaglandin synthesis.
iii) Inhibit platelet aggregation and prolong bleeding.
iv) Less gastric irritation compared to aspirin but yet
the most common side effects are gastrointestinal.
v) All are well absorbed orally.
vi) Other side effects like headache. Dizziness and
vertigo.

24. 1. IBUPROFEN
 Enters synovial space slowly but remains there in
high concentrations for a long time.
 Interacts with coumarin and augments its effect.
 When used with aspirin, the net antiinflammatory
effect is reduced.
 Not indicated in pregnant women and in asthmatcs.
 Dose – 200 to 400 mg tds.

25. 2. NAPROXEN
 Absorption when given orally is reduced by
aluminium hydroxide.
 Dose – 250 mgs twice daily.
 Anthranilic acid derivatives.
 A family of aspirin like drugs.

26. 3. MEFANAMIC ACID AND FLUFENAMIC
ACID
 As an antiinflammatory 1.5 times as powerful
as phenylbutazone.
 Has central and peripheral analgesic action .
Also antipyretec. Inhibits prostaglandin
synthesis.
 Diarrhoea most common side effect.
 Dose – 500 mgs orally thrice daily.

27. Enfenamic acid (tromaril)
 Extremely effective to control acute
inflammations like inflammation following
surgery. Also effective in chronic
inflammations.
 In has an antiprostaglandin effect. Gets
localized in inflamed tissues. Good hastric
tolerance.
 Dose – 400 mgs orally twice daily.

28. 1.DICLOFENAC
 A phenyl acetic acid derivative.
 Possesses analgesic, antipyretic and
antiinflammatory activity similar to
IBUPROFEN.
 The drug accumulates in synovial fluid and
hence an ideal drug in arthritis.
 Causes GI tract irritation.
 Dose – 150 mgs twice daily.

29. 2. TOLMETIN
 An antiinflammatory, analgesic and antipyretic
persists in synovial fluid for about 8 hours after a
single oral dose and hence an excellent drug for
arthritis.
 GI bleeding, dyspepsia, drowsiness are the side
effects.
 Dose – 200 mgs thrice daily.

30. Oxicam derivetives
1.PROXICAM
 Equivalent to aspirin in long tern treatment of
arthritis.
 Half life 50 hours.
 Can cause GI tract bleeding and alteration in
platelet function.
 Causes bronchoconstriction in patients
hypersensitive to aspirin.
 Dose – 20 mg once daily.

31. Thank you