Comparative Evaluation of Intranasal Butorphanol and Oral Diclofenac Sodium for Analgesia After Surgical Removal of Impacted Mandibular Third Molars: Split-Mouth Prospective Controlled Clinical Study.

Abstract

The study intended to compare the analgesic effect and patient satisfaction of intranasal butorphanol with oral diclofenac sodium after surgical removal of impacted mandibular third molars. This split-mouth prospective controlled clinical study included 50 patients with bilateral symmetrically impacted mandibular third molars with the same difficulty on the Pederson Index. All patients had two appointments of surgery. In the first, the molar on one side was surgically removed and depending upon the chit selected by the patient, either intranasal butorphanol or oral diclofenac sodium was prescribed postoperatively for pain relief. Two weeks later, the impacted mandibular third molar on the other side was surgically removed and if butorphanol was selected for the first side, then oral diclofenac sodium was prescribed for the other side and vice versa. Pain relief was recorded on the Facial Visual Analogue Scale at 1, 2, 3, 4 and 5h postoperatively and on postoperative day 1 and 2 at the same time for both the drugs. Intensity of pain was less with intranasal butorphanol as compared to oral diclofenac sodium at all the time intervals and especially in the 1st postoperative hour. Overall acceptance (88%) to butorphanol nasal formulation was statistically similar to diclofenac sodium tablets. Intranasal butorphanol at the very acceptable 1mg dose after the surgical removal of impacted mandibular third molars provides a profound degree of analgesia. It is a well-tolerated drug with a high acceptance rate if administered correctly.