Preemptif Tek Doz Sürekli Salınımlı Non-steroid Antienflamatuar İlaçların Üçüncü Molar Cerrahisi Sonrası Postoperatif Komplikasyonlar Üzerine Etkileri

Amaç: Bu çalışmanın amacı, üçüncü molar cerrahisini takiben iki preemptif sürekli salınımlı nonsteroidal antienflamatuar ajanın ağrı, ödem ve trismus açısından etkinliğini karşılaştırmaktır. Yöntem: Çift taraflı vertical pozisyonda gömülü üçüncü azı dişleri olan 30 hasta çalışmaya dahil edildi. Çalışma randomize ve çift kör olarak planlandı. Ameliyattan 30 dakika önce hastalara 75 mg sürekli salınımlı (SR) deksketoprofen trometamol verildi ve ameliyat sonrası ilaç uygulaması günde bir kez olmak üzere 1 hafta boyunca devam etti. 2 hafta sonra, 75 mg sürekli salınımlı (SR) diklofenak sodyum ile diğer gömülü üçüncü molar için aynı prosedür uygulandı. Ağrı postoperatif 6., 8., 12., 24. ve 48. saatlerde ve 3., 5. ve 7. günlerde VAS (Görsel Analog Skala) ile değerlendirildi. Ödem ve trismus ölçümleri postoperatif 2. ve 7. günlerde gerçekleştirildi. Bulgular: 6., 8., 12., 24. ve 48. saatlerde ve 3. ve 5. günlerde VAS düzeylerinde gruplar arasında istatistiksel olarak anlamlı bir fark bulundu (p <0.01). Deksketoprofen trometamol SR grubunun VAS düzeyleri, diklofenak sodyum SR grubundan daha düşüktü. Gruplar arasında 2. ve 7. günlerde trismus ve ödem ölçüm ortalamaları açısından istatistiksel olarak anlamlı fark yoktu (p <0.05). Sonuç: Deksketoprofen trometamol SR ve diklofenak sodyum SR, gömülü üçüncü molar cerrahisini takiben ödem ve trismusun azaltılması için benzer şekilde etkilidir; bununla birlikte, deksketoprofen trometamol SR'nin ağrıyı azaltmada daha etkili olduğu bulunmuştur.

Anahtar Kelimeler:

Üçüncü azı dişi, Postoperatif komplikasyonlar, Sürekli-salınımlı preparatlar, Non-steroid anti-inflamatuar ajanlar

Effects of Preemptive Single Dose Sustained Release Non-Steroidal Anti-Inflammatory Drugs on Postoperative Complications Following Third Molar Surgery

Objective: The aim of this study was to compare the effectiveness of two preemptive sustained-release nonsteroidal antiinflammatory agents in terms of pain, edema and trismus following third molar surgery. Method: Overall, 30 patients with double-sided vertically positioned impacted third molars were included in this study. The study was randomized and double-blinded. 30 minutes before the surgery, patients were given sustained-release (SR) dexketoprofen trometamol 75 mg and following the surgery the drug administration continued postoperatively for 1 week, once a day. 2 weeks later, the same procedure was applied for the counterside impacted third molar with sustained-release (SR) diclofenac sodium 75 mg. The pain was assessed postoperatively by VAS levels at the 6th, 8th, 12th, 24th and 48th hours and on the 3rd, 5th, and 7th days. Edema and trismus measurements were evaluated on the postoperative 2nd and 7th days. Result: There was a statistically significant difference between the groups in VAS levels at 6th, 8th, 12th, 24th, and 48th hours, and on the 3rd and 5th days (P <0.01). VAS levels of dexketoprofen trometamol SR group had lower VAS levels than diclofenac sodium SR group. There was no statistically significant difference between the groups in terms of trismus and edema measurement averages on the 2nd and 7th days (P <0.05). Conclusion: Dexketoprofen trometamol SR and diclofenac sodium SR are similarly effective for the reduction of edema and trismus following impacted third molar surgery; however, dexketoprofen trometamol SR is found to be more efficient in reducing pain.

Keywords:

Third molar, postoperative complications, sustained-release preparations, nonsteroidal anti-inflammatory agents,

PDF

___

1. Al-Zoubi H, Alharbi AA, Ferguson DJ, Zafar MS. Frequency of impacted teeth and categorization of impacted canines: a retrospective radiographic study using orthopantomograms. Eur J Dent. 2017;11(1):117-121.
2 Farhadi F, Eslami H, Majidi A, Fakhrzadeh V, Ghanizadeh M, KhademNeghad S. Evaluation of adjunctive effect of low-level laser Therapy on pain, swelling and trismus after surgical removal of impacted lower third molar: A double blind randomized clinical trial. Laser Ther. 2017;26(3):181-187.
3. Nazir A, Akhtar MU, Ali S. Assessment of different patterns of impacted mandibular third molars and their associated pathologies. J Adv Med Dent Sci Res. 2014;2:14-22.
4. O'Hare PE, Wilson BJ, Loga MG, Ariyawardana A. Effect of submucosal dexamethasone injections in the prevention of postoperative pain, trismus, and oedema associated with mandibular third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2019;48(11):1456-1469.
5. Osunde O, Adebola R, Omeje U. Management of inflammatory complications in third molar surgery: a review of the literature. African health sciences. 2011;11(3):530-37.
6. Rodrigues ÉD, Pereira GS, Vasconcelos BC, Ribeiro RC. Effect of preemptive dexamethasone and etoricoxib on postoperative period following impacted third molar surgery-a randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2019;24(6):e746-e751.
7. Barbalho JC, Vasconcellos RJ, de Morais HH, Santos LA, Almeida RA, Rêbelo HL. Effects of co-administered dexamethasone and nimesulide on pain, swelling, and trismus following third molar surgery: a randomized, triple-blind, controlled clinical trial. Int J Oral Maxillofac Surg. 2017;46:236-42.
8. Barbanoj MJ, Antonijoan RM, Gich I. Clinical pharmacokinetics of dexketoprofen. Clin Pharmacokinet. 2001;40(4):245-62.
9. Fineschi G, Tamburrelli FC, Francucci BM, Pisati R. Oral diclofenac dispersible provides a faster onset of analgesia than intramuscular ketorolac in the treatment of postoperative pain. Clin. Drug Invest 1.997;13:1‐7.
10. López-Carriches C, Martínez-González JM, Donado-Rodríguez M. Analgesic efficacy of diclofenac versus methylprednisolone in the control of postoperative pain after surgical removal of lower third molars. Med Oral Patol Oral Cir Bucal. 2005;10(5):432-9.
11. Zuniga JR, Phillips CL, Shugars D, Lyon JA, Peroutka SJ, Swarbrick J, et al. Analgesic safety and efficacy of diclofenac sodium softgels on postoperative third molar extraction pain. J Oral Maxillofac Surg. 2004;62(7):806-15.
12. Suzuki T, Kosugi K, Suto T, Tobe M, Tabata Y, Yokoo S, et al. Sustained-release lidocaine sheet for pain following tooth extraction: A randomized, single-blind, dose-response, controlled, clinical study of efficacy and safety. PLoS One. 2018;13(7):e0200059.
13. Nagatsuka C, Ichinohe T, Kaneko Y. Preemptive effects of a combination of preoperative diclofenac, butorphanol, and lidocaine on postoperative pain management following orthognathic surgery. Anesth Prog. 2000;47(4):119-124.
14. Üstün Y, Erdoğan Ö, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):535-539.
15. Cebi A, Kasapoglu MB, Eren S, Kasapoglu C. Comparison of the Effects of Diclofenac Potassium and Tenoxicam on Postoperative Pain, Swelling, and Trismus Following Third Molar Surgery. Turk J Med Sci. 2018;48(2):271-278.
16. Alcântara CE, Falci SG, Oliveira-Ferreira F, Santos CR, Pinheiro ML. Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg. 2014;43(1):93-98.
17. Jiménez-Martínez E, Gasco-García C, Arrieta-Blanco JJ, Gomez del Torno J, Bartolome Villar B. Study of the analgesic efficacy of Dexketoprofen Trometamol 25mg. vs. Ibuprofen 600mg. after their administration in patients subjected to oral surgery. Med Oral. 2004;9(2):143.
18. de Souza GM, Fernandes IA, Dos Santos CRR, Falci SGM. Is bromelain effective in controlling the inflammatory parameters of pain, edema, and trismus after lower third molar surgery? A systematic review and meta-analysis. Phytother Res. 2019;33(3):473-481.
19. Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002;96(3):725-741.
20. Kelsaka E, Güldoğuş F, Cetinoğlu E. Effect of intravenous dexketoprofen use on postoperative analgesic consumption in patients with lumbar disc surgery. Agri. 2014;26(2):82-6.
21. Pandit MK, Godhi S, Lall AB. Preoperative intravenous tramadol versus diclofenac for preventing postoperative pain after third molar surgery: a comparative study. J Maxillofac Oral Surg. 2011;10(4):306-309.
22.Akbulut N, Ustuner E, Atakan C, Colok G. Comparison of the effect of naproxen, etodolac and diclofenac on postoperative sequels following third molar surgery: A randomised, double-blind, crossover study. Med Oral Patol Oral Cir Bucal. 2014;19(2):e149–e156.
23. Eroglu CN, Durmus E, Kiresi D. Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: a pilot study Med Oral Patol Oral Cir Bucal. 2014;19(6):622-627.
24. Kesimci E, Gümüs T, Kanbak O. Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients. Agri. 2011;23(4):153-159.
25. Nunamaker EA, Stolarik DF, Ma J, Wilsey AS, Jenkins GJ, Medina CL. Clinical efficacy of sustained‐release buprenorphine with meloxicam for postoperative analgesia in beagle dogs undergoing ovariohysterectomy JAALAS. 2014;53(5):494-501.
26. Seymour TL, Adams SC, Felt SA, Jampachaisri K, Yeomans DC, Pacharinsak C. Postoperative analgesia due to sustained-release buprenorphine, sustained-release meloxicam, and carprofen gel in a model of incisional pain in rats (Rattus norvegicus). JAALAS. 2016;55(3):300-305.
27. Gülhaş N, Durmuş M, Yücel A, Şahin T, Erdil FA, Yoloğlu S, et al. Comparison of Analgesic Effects of Intravenous Dexketoprofen Trometamol, Lornoxicam and Paracetamol on Postoperative Pain After Total Abdominal Hysterectomy. Turk J Anaesthesiol Reanim. 2011;39:176-81.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez