Tramadol Administered in a Combination of Routes for Reducing Pain After Removal of an Impacted Mandibular Third Molar

Abstract

Patients typically associate dental care with pain, and an experience of poorly managed pain related to dental treatment can lead patients to avoid or postpone treatment. 1 Removal of an impacted mandibular third molar causes swelling, difficulty in opening the mouth (trismus), and pain. 2-4 The reasons for third molar removal are varied. Surgery to extract an impacted third molar due to, for example, pericoronitis, infection, caries, pain, or cyst or tumor formation, or to facilitate orthodontic treatment, is a common dental procedure in clinical practice. The procedure is a common model for testing the efficacy of analgesics for acute dental pain. 5,6 There are different strategies for pain management. Preoperative administration of analgesics reduces the onset of postoperative pain. 7 An alternative approach to pain control is to maximize drug levels at the site of tissue injury by administering drugs locally, which also minimizes systemic exposure. Some administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to a peripheral site of tissue injury results in greater analgesia than afforded by oral administration. 8 Combining drugs or combining different routes of administration of the same drug can increase the duration of analgesic effect. Combinations that target both peripheral and central pain pathways have different onset times and durations of action. Different sites of action can enhance an analgesic’s capacity to minimize pain, and additive and synergistic effects may allow for lower doses. 9,10 Some adjuncts to local anesthetics for peripheral blockade have been proposed to enhance the quality and duration of anesthesia and postoperative analgesia. Such adjuncts include clonidine, antidepressants, and opioids, including tramadol. 11-15