Does Pre-Emptive Administration of Intravenous Ibuprofen (Caldolor) or Intravenous Acetaminophen (Ofirmev) Reduce Postoperative Pain and Subsequent Narcotic Consumption After Third Molar Surgery?

Abstract

Pre-emptive analgesia is known to reduce postoperative pain after third molar removal. The purpose of this study was to compare postoperative pain in patients receiving either preoperative intravenous (IV) ibuprofen or preoperative IV acetaminophen for third molar surgery. This study was a randomized, single-blinded clinical study conducted in patients undergoing surgical extraction of 2 or more impacted third molars under deep sedation. This study compared 2 interventions: 800mg of IV ibuprofen (Caldolor; Cumberland Pharmaceuticals, Nashville, TN) and 1,000mg of IV acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom).The primary outcome variable was postoperative pain measured on a visual analog scale at different time points. The secondary outcome variable was the amount of postoperative analgesic (narcotic and over-the-counter) medication taken in both groups. The Mann-Whitney U test was used to compare groups in terms of outcomes, the χ2 test was used to assess associations between nominal variables, and Spearman correlations were used to assess associations between continuous variables.Significance was set at P<.05. The study sample consisted of 58 patients (39 female and 19 male patients). A total of 41 patients (IV ibuprofen, n=19; IV acetaminophen, n=22) completed the study. Equal distributions of age, gender, and number of impacted teeth were noted between the groups. At 4hours postoperatively, the pain level in the ibuprofen group was significantly lower than that in the acetaminophen group (P=.004). This trend continued at 24hours (P=.019) and 48hours (P=.017). The average amount of narcotic medication taken in the ibuprofen group (2.68±2.26 doses) was lower than that in the acetaminophen group (7.32±6.68 doses), and the result was statistically significant (P=.005). Pre-emptive analgesia with IV ibuprofen is more effective than IV acetaminophen in reducing postoperative pain and opioid use for third molar surgery.