Abstract
BackgroundThis study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery.Material and MethodsA randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects.ResultsSignificant differences in pain intensity were observed in the different times (p<0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p<0.001), the need of antiemetic were greater in Group K+T+A (p<0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A.ConclusionsThe current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant. Key words:Ketorolac, molar, third, surgery, oral, Tramadol, Acetaminophen.
Highlights
Third molar surgery is often accompanied by postoperative complications such as pain, buccal swelling and trismus [1]
Numerous studies have investigated alternatives for the management of pain and discomfort generated by third molar surgery [5]
Perhaps combining a nonsteroidal anti-inflammatory drug (NSAID) such as ketorolac with opioid analgesics such as tramadol/acetaminophen may lead to lower postoperative pain
Summary
Third molar surgery is often accompanied by postoperative complications such as pain, buccal swelling and trismus [1]. Among the nonsteroidal anti-inflammatory drugs investigated, ketorolac is one of the pharmacological options available, it is reported to have a potent analgesic effect similar to opioids [6] as well as a moderate antiinflammatory activity [7], which seems adequate for the treatment of moderate-to-severe acute pain [8]. Due to these characteristics, this drug has been investigated for pain control after third molar surgeries. The combination group showed lower pain at 9 h, the difference is small and not clinically relevant
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