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Pain is the most common symptom bringing patients to dental office. Despite its prevalence it’s very challenging to manage pain in day today practice. Often the dental treatment alone can provide a great relief from pain such as immediate reduction of pain following an incision and drainage of an abscess or the relief that can be accomplished by removal of an affected tooth. So the next step will be towards managing the post-operative pain.
Surgical removal of third molar is one of the common procedures done by oral and maxillofacial surgeons, this procedure involves incisional and inflammatory injuries that results in pain, swelling, trismus in the post-operative period. The first 12 hours following removal of the tooth is considered as most unpleasant experience. This can be reduced by use of pre-emptive analgesia that is started before the beginning of the surgery. It has a great impact on the patient’s pain perception , .
During the perioperative period, there is a flow of nociceptive signals from the operating site. It has a dual phase character, the initial phase or the first phase results from injuries produced by the surgical procedure, the second phase of nociceptive stimulation is due to the inflammatory responses associated with the tissue injury.
The peripheral tissue injury provokes two kinds of modification in the responsiveness of the nervous system: Peripheral sensitisation, a reduction in the threshold of nociceptor afferent peripheral terminals and Central sensitisation, an actively dependant increase in the excitability of spinal neurons. Together these changes contribute to post injury pain hypersensitivity state found post operatively. This manifest as increase in response to noxious stimuli and a decrease in pain threshold both at the site of injury and in the surrounding uninjured tissue. The sensory signals generated by the tissue damage during the surgery can produce an increased excitability in the central nervous system. The role of Preemptive analgesia is that it blocks the initiation of central sensitisation evoked by incisional and inflammatory injuries occurring during surgery and in initial post-operative period. It leads to effective reduction in the development of Peripheral and Central sensitisation – the reason for primary and secondary hyperalgesia. Primary hyperalgesia refers to pain sensitivity in the surgical site, whereas secondary hyperalgesia refers to pain sensitivity in the surrounding tissues.
Thus successful post-operative pain control can be achieved by
This idea of preventing pain was first introduced by Crile in 1913, which was further developed by Wall and Woolf. They suggested that simply changing the timing of treatment can have better effects on post-operative pain.
Various pre-emptive agents can be used for effective pain management among them are NSAID’S. The Main mechanism of action of NSAIDs are inhibition on cyclooxygenase activity as a result there is inhibition of prostaglandins which has a proinflammatory effect.
We have compared Aceclofenac 100 mg and Piroxicam 20 mg given orally one hour before the surgery among patients undergoing surgical removal of impacted third molar. With the help of our prospective randomised double blind study we have compared the efficacy of Aceclofenac and Piroxicam as pre-emptive analgesic for preventing postoperative pain after third molar surgery.
Study location: The study was conducted among patients reporting to the Department of Oral and Maxillofacial Surgery for surgical removal of impacted third in a private Dental College, Chennai, Tamil Nadu, India.
The study was conducted among 50 subjects, who were randomly grouped into two groups- Aceclofenac group (A) and Piroxicam group (B).
The Aceclofenac group (A) comprised of 25 individuals, who were given Aceclofenac 100mg preoperatively 1 hour before the procedure.
The Piroxicam group (B) comprised of 25 individuals, who were given Piroxicam 25mg preoperatively 1 hour before the procedure. All the subjects were explained about this study in detail and the possible complications in the study and all the patients were given informed consent.
The patient, the operating surgeon were all blinded during the study process, all the patients were evaluated by one principal investigator.
Each patient was assessed before the procedure for any pain, if they had pain their score was recorded in the Visual Analogue Scale, followed by 24 hours post operatively followed by 3rd and 5th day for pain. Patient’s mouth opening was assessed before the procedure, followed by 3rd and 5th day.
Pain measurement was done using Visual Analogue Scale (VAS) on a scale of 0 to 10.
Statistical analysis: The collected data from the patients was analysed by using IBM.SPSS statistics software 23.0 Version. The obtained data from the VAS was measured by mean & S.D was used and to find the significant difference between the bivariate samples in Paired groups, the Wilcoxon signed rank test was used. Further to analyse the independent groups of samples, the Mann-Whitney U test was used. For the multivariate analysis in repeated measures, the Friedman test followed by the Wilcoxon signed rank test was used. For all the statistical analysis, the probability value of .05 is considered as significant.
The study group included 50 patients and splitted the sample into two groups like group A and B, each group has 25 patients, who underwent surgical removal of third molars.
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