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Effects of pre operative administration of diclofenac.
JKCD December 2010, Vol. 1, No. 1
Original Article
EFFECTS OF PRE OPERATIVE ADMINISTRATION OF
DICLOFENAC POTASSIUM ON PAIN INTENSITY
FOLLOWING IMPACTED MANDIBULAR
THIRD MOLAR SURGERY
Dr. Shuja Riaz Ansari, BDS, MDSc (Leeds), Associate Professor, Department of Oral & Maxillofacial Sur-
gery, Khyber College of Dentistry, Peshawar, Pakistan
Dr. Umar Khitab, BDS, MSc (London), Associate Professor, Department of Oral & Maxillofacial Surgery,
Khyber College of Dentistry, Peshawar, Pakistan
Dr. Basheer Rehman, BDS, MCPS, Demonstrator, Department of Oral Pathology, Khyber College of Den-
tistry Peshawar, Pakistan
ABSTRACT
Objectives: To evaluate the effect of pre operatively administered Diclofenac potassium, on the postoperative
management of pain following removal of impacted lower third molars.
Material and Methods: The study was carried out in the Department of Oral and Maxillofacial Surgery,
Khyber College of Dentistry, Peshawar, from Jan 2009 to June 2009. Fifty patients were recruited in this study who
were equally distributed into group I and group II. Post operative pain was assessed using a four-point Category
Rating Scale.
Results: In this study more males were recruited than females and the ratio of male to female was 2:1. Majority of
the patients (56%) recruited were in 3rd decade of life followed by 4th decade (32%). In group I, 80% were those who
had no post operative pain after 48 hours while in group II 86% of the patients showed moderate to severe pain
postoperatively.
Conclusion: This study illustrated the enhanced effects of preoperative administration of Diclofenac potassium on
short-term postoperative pain, compared to those patients who do not receive diclofenac potassium prior to third molar
surgery.
Keywords: Mandibular third molar, Pain intensity, Diclofenac potassium, Impacted.
INTRODUCTION
ence pain and swelling alone or in combinations, com-pared to those who were asymptomatic. Many clini- Surgical removal of wisdom teeth under local cians have, thus, emphasized the necessity for better anaesthesia is widely carried out in general dental prac- pain and swelling control in patients who undergo tice as well as in many Oral & Maxillofacial Surgical clinics and occupies an appreciable amount of clini-cal time.1,2 Postoperative pain and swelling are usually The introduction of Non-steroidal anti-inflam- associated with this procedure as direct and immedi- matory drugs (NSAIDs) e.g. Diclofenac potassium has ate consequences.3 The adverse effects of the wisdom significantly altered the management of postopera- tooth surgery on the quality of life has been reported tive pain in dentistry.6 There are two possible mecha- to show a three-fold increase in patients who experi- nisms for the efficacy of NSAIDs when administered Correspondence:
prior to surgical trauma. The first may simply be a Dr. Shuja Riaz Ansari
pharmacokinetic advantage. By administering the NSAIDs prior to pain onset, drug absorption would Department of Oral & Maxillofacial Surgery have begun and therapeutic blood level will be present at the time of pain onset. Second, the presence of a cyclooxygenase inhibitor at the surgical site may limit Effects of pre operative administration of diclofenac.
JKCD December 2010, Vol. 1, No. 1
the production of prostaglandins and prostacyclins of cases, followed by disto-angular impaction (20%) associated with hyperalgesia and edema.7,8,9 as shown in Table 2. Except at the pain score 1, highly The aim of this study was to evaluate the effect significant difference was found in two groups regard- of pre operatively administered diclofenac potassium, ing the pain levels. Patients with pain score 0 were on the postoperative management of pain following significantly greater (p= 0.000) in group I while pa- removal of impacted lower third molars.
tients with pain score of 2 and 3 were significantlygreater (p= 0.000, 0.009 respectively) in group II as MATERIAL AND METHODOLOGY
compared to group I. In group I, 80% patients had Fifty patients who attended the Department of no postoperative pain after 48 hours while 84% pa- Oral and Maxillofacial of Khyber College of Den- tients of group II had moderate to severe pain post- tistry, Peshawar, from January 2009 to June 2009, re- operatively. The details of pain intensity score is given quiring surgical removal of impacted mandibular third molar teeth under local anaesthesia were recruited in Table 1: Age Distribution
this study. Patients who had taken other analgesic drugswithin 24 hours before surgery were excluded from Age in years
Frequency
Percentage
the study. All recruited patients were free of pain. They were divided into two groups. In Group I, patientswere given pre operative diclofenac potassium 50 mg orally starting 12 hours before the procedure and an- other dose given half an hour prior to surgery. GroupII comprised of patients who were given no analge- sics pre operatively. The degree of surgical difficulty was assessed using Winter’s and Pell-Gregory crite-ria10. Surgical extraction of the third molars was car- Table 2: Type of Impaction
ried out with elevation and reflection of buccal mu- Type of impaction
Percentage
coperiosteal flap under local anaesthesia. Post opera-tive pain was assessed using a four-point Category Rating Scale11 in which pain was recorded as: No pain (patient experiences no discomfort) Moderate pain (noticeable pain, but patient canstill engage in routine daily activities) Table 3: Pain intensity score
Severe pain (very noticeable pain which disturbs Pain score
Z-test was applied to compare the pain score Fifty patients were recruited in this study. Out of these, 33 were male while 17 were female with male to female ratio of 2:1. Majority of these patients (36%)were in age group of 21-25 years, followed by 20% in DISCUSSION
the age group of 26-30 years. The mean age of thesepatients was 27.3 By pharmacologically controlling the extent of the inflammatory process, the intensity or severity ofpostoperative sequelae such as pain, may be reduced.4 Radiographic analysis of the type of impactions One technique for post operative pain reduction is to showed that mesio-angular impaction constituted 52% control the synthesis of prostaglandins. Prostaglan- Effects of pre operative administration of diclofenac.
JKCD December 2010, Vol. 1, No. 1
dins play a major role in the induction of pain, in- REFERENCES
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flammatory response may decrease the sequelae oftissue trauma; especially the accompanying pain.10,11 Jackson DL, Moore PA, Hargreaves KM. Preoperative Diclofenac potassium has been shown to be useful in nonsteroidal anti-inflammatory medication for the pre-vention of postoperative dental pain. JADA 1989; 119: controlling postoperative pain after removal of third White RP Jr, Offenbacher S, Phillips C, Haug RH, The present study assessed the clinical effect of Blakey GH, Marciani RD. Inflammatory mediators and Diclofenac potassium on pain. The pattern of post- Periodontitis in patients with asymptomatic third mo-lars. J Oral Maxillofac Surg 2002; 60: 1241-5.
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CONCLUSION
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preoperative administration of diclofenac potassium Ross R, White CP: Evaluation of hydrocortisone in on short term postoperative pain, compared to those prevention of postoperative complications after oral patients who do not receive Diclofenac potassium surgery: a preliminary report. Journal of Oral Surgery Effects of pre operative administration of diclofenac.
JKCD December 2010, Vol. 1, No. 1
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Source: http://jkcd.org.pk/Issues/2010-2/KCD-8.pdf

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