Abstract
Background The efficacy of preemptive analgesia in managing postoperative pain remains controversial. The aim of this study was to compare the efficacy of intravenous (IV) acetaminophen administered before or immediately after the surgical extraction of an impacted mandibular third molar. Material and Methods This prospective randomized clinical trial included 120 patients. The patients were assigned to one of three groups: the preoperative-treatment group (pre-group), which received 1000 mg of IV acetaminophen 20 min before surgery; the postoperative-treatment group (post-group), which received 1000 mg of IV acetaminophen after surgery; the no-treatment group (control-group), which did not receive any analgesic. Rescue analgesic (60 mg loxoprofen) was issued to each patient, with instructions on self-administration if needed. For the rescue medication usage, the time of first loxoprofen usage and the total amount of loxoprofen consumption were obtained for a 17-hour period after surgery. We measured pain using the visual analogue scale at 1 hour and at 2, 3, 4, 5, and 15 hours after surgery. Results There was no significant difference in pain level among the three groups at any time interval. However, the pre-group demonstrated significantly lower rescue analgesic consumption and longer time until initial administration. Conclusions Administration of IV acetaminophen before third molar surgery provides more effective pain control than postoperative administration and no treatment. Key words:Preemptive analgesia, acetaminophen, impacted third molar, pain relief, randomized controlled trial.
Highlights
The extraction of wisdom teeth, or third molars, is the most common procedure in the field of oral and maxillofacial surgery
The preemptive analgesia approach in which intervention precedes incision offers a more effective means of controlling postoperative pain and preventing central sensitization and chronic neuropathic pain than identical interventions applied after the incision [8]
Previous studies that have attempted to assess the efficacy of preemptive analgesia in patients undergoing oral surgery used protocols in which the outcome of preoperative administration was only compared against outcomes of either preoperative placebo administration [13] or postoperative analgesic administration [14]
Summary
Journal section: Oral Medicine and Pathology Publication Types: Research doi:10.4317/medoral.23983. Med Oral Patol Oral Cir Bucal. 2021 Jan 1;26 [1]:e64-70
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