Abstract
Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin) when compared with 20 mg piroxicam alone (Feldene) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.
Highlights
Pain after third molar extraction has become the model most frequently used in acute pain trials
The pain and swelling resulting from the surgery are generally caused by different factors, such as surgical trauma or endotoxins, which are treated with various therapeutic agents, including nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., piroxicam, diclofenac, celecoxib), antibiotics, and others [2]
Neither 5 nor 10 mg piroxicam produced clinically significant analgesia, higher doses were significantly superior to placebo, and both the 20- and 40-mg doses were comparable to 648 mg aspirin during the initial 6 h
Summary
Pain after third molar extraction has become the model most frequently used in acute pain trials. The reason is that third molar extraction is a common procedure accompanied frequently by pain of moderate or severe intensity, and involves sufficient numbers of patients to make studies relatively easy to perform [1]. Neither 5 nor 10 mg piroxicam produced clinically significant analgesia, higher doses were significantly superior to placebo, and both the 20- and 40-mg doses were comparable to 648 mg aspirin during the initial 6 h. Piroxicam at 20 and 40 mg produced a significantly longer duration of analgesia than did 648 mg aspirin, and the analgesic effect of piroxicam appears to last for up to 24 h in a substantial number of patients [3]. 20 or 40 mg piroxicam induces the typical side effects of this drug class such as gastroduodenal hemorrhagic episodes or renal function damage
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