"INTRAMUSCULAR ADMINISTRATION OF KETOROLAC VERSUS TRAMADOL POST OPERATIVELY IN MINOR ORAL SURGERY"

Dr Anand Mangalgi, Dr. deepika Mallasure, Dr Kundan Shah, Dr. Sangmesh Sajjanshetty, Dr. Supriya Patil, Dr. Sudha Halkai

Abstract


Background  & Objectives

 

Surgical    removal    of   impacted   mandibular   third    molars    is   a   procedure frequently  carried  out on an out-patient basis and  analgesia   is  necessarily  a balance  between  achieving adequate  pain  relief while  causing  minimum side  effects. Pain  is  a  common   complaint  often  occurring   with  inflammatory  processes  after  a tooth  extraction.  Postoperative   pain  following  surgical  removal  of  a 

mandibular  third   molar   is   validated,    well  documented  and  highly   sensitive   model   to   assess therapeutic  relief of moderate to severe  pain.  The  ultimate  goal  of oral  health  care providers   is  not  only  to  restore  function,   but  also  to  relive  pain.   Analgesics  are commonly  prescribed  to  alleviate  pain  induced  by  the  inflammation.  Patients  with post - operative  pain are currently treated with  various  drugs in two main categories:

i)                  Non - steroidal  anti - inflammatory drugs (NSAIDS)

ii)               Narcotic  analgesics.

Ketorolac  is a potent  NSAID  that avoids  the problems associated with narcotic analgesics  [potential  for  addiction,  drug tolerance  and  respiratory  depression   while still  achieving  a narcotic   like  efficacy.  Tramadol   is  a synthetic   analogue   of codeine and  causes  minimal   respiratory depression,  few gastrointestinal  effects and  has  less potential  for opioid  like dependence. The objective of this study  was  to compare  the analgesic   efficacy   of post  - operative   intramuscular    ketorolac   versus  tramadol  in preventing post-operative pain after  mandibular third molar  surgery.

 

Patients & Method

 

Forty  patients under the age group  of 16 - 40 yrs with asymptomatic  impacted mandibular third  molars were  randomly  assigned into  one  of  the  two  groups (20  in each   group),  and   underwent  third  molar   surgery  under  local  anesthesia.  Group   I received   IM   ketorolac   30mg    and   Group   II   received  tramadol   50   mg   post   - operatively. The  difference  in  post  - operative pain  was  assessed by  five  primary  end points  :     pain  intensity  measured every hourly  by a I0  cm   visual  analogue scale  for  12 hours,  onset   of  analgesia,  duration  of  action,   total   no  of  analgesics  consumed,  and  patient's global  assessment.

 

Result

 

Throughout  the  12  hours  investigation  period, patients  reported significantly lower   pain    intensity   scores,   longer   duration  of  action,    lesser   post   - operative analgesics consumption  and  better  global  assessment in ketorolac when  compared  to tramadol group.  Patients in the ketorolac group  significantly performed better than the tramadol  group   in  terms   of all  parameters  except   onset   of analgesia.  All  the  drug related  complications were  mild  and did not require any  intervention.

 

Conclusion

 

The   results    of  the   present  study  shows    that   post-operative   intramuscular ketorolac  30   mg   is  more   effective  than   tramadol  50  mg   for  post-operative  pain following third  molar surgery.


Keywords


Ketorolac ; Tramadol ; Pain ; Third molar surgery

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References


. Mellor DJ, Mellor AH, Mcateer EM. Local anesthetic infiltration for surgical exodontias of third molar teeth: a double blind study comparing bupivacaine infiltration with i.v. Ketorolac , British Journal of Anesthesia 1998;81:pp.511-514.

. Pozos AJ, Martinez R, Aguirre P, Perez J. Tramadol Administered in a Combination of Routes for Reducing Pain After Removal of an Impacted Mandibular Third Molar. J Oral Maxillofac Surg 2007;65:pp.1633-1639.

. Shipton EA, Roelofse JA, Blignanut RJ. An evaluation of analgesic efficacy and clinical acceptability of intravenous tramadol as an adjunct to propofol sedation for third molar . Anesth prog 2003;50:pp121-128.

. Tarkkila P, Tauominen M, Rosenberg H. Intravenous ketorolac versus diclofenac for analgesia after maxillofacial surgery . Can J Anaesth 1996;43(3):pp.216-220.

. Ong KS. Tan JML. Preoperative intravenous tramadol versus oral tramadol for preventing postoperative pain after third molar surgery . Int J Oral Maxillofac surg 2004;33pp.274-278.

. Garibaldi JA, Elder MF. Evaluation of ketorolac (Toradol) with varying amounts of codeine for postoperative extraction pain control. Int J Oral Maxillofac Surg 2002;31:pp.276-280.

. Pozos-Guillen A, Martinez-Rider R, Aguirre-Banuelos P, Perez-Urizar J. Pre-Emptive Analgesic effect of tramadol after mandibular third molar extraction : a pilot study . J Oral Maxillofacial Surgery 2007;65:pp.1315-1320.

. Mehlisch DR. The efficacy of combination analgesic therpy in relieving dental pain. J Am Dent Assoc 2002;133:pp.861-871.

. Lanzetta A, Vizzardi M, Letizia G, Matorona U, Sanfilliop A, Osti L, et al. Intramuscular tramadol versus ketorolac in patients with orthopaedic and traumatologic postoperative pain : A comparative multicenter trail. Current Therapeutic Research January 1998;59(1):pp.39-46.

. Tuzuner AM, Ucok C, Kucukyavuz Z, Alkis N, Alanoglu Z, Preoperative diclofenace sodium and tramadol and pain relif after bimaxillary osteotomy . J Oral Maxillofical Surgery 2007;65:pp.2453-2458.

. Collins M, Young I, Sweeney P, Fenn GC, Stratford ME, Wilson A, et al. The effect to tramadol on dento-alveolar surgical pain. British journal of Oral and Maxillofical Surgery 1997;35:PP.54-58.

. Colletti V, Carner M, Vineenzi A, Dallari S, Mira E, Benazzo M, et al. Intramuscular tramadol versus ketorolac in the treatment of pain following nasal surgery : a controlled multicenter trial current Therapeutic Research 1999;59(9):pp.608-618.

. Shah zaeem k, Ibrahim MW, Hussain I. Hassan A. Comparision of analgesic efficacy of tramadol hydrochloride with diclofenac sodium in dento-alveolar surgery. Pakistan Oral & Dental Journal 2007;28(2):pp.241-244.

. Cliff Ong KS, Lirk P, Tan Juliana MH, Snow Belle WY. The analgesic efficacy of intravenous versus oral tramadol for preventing postoperative pain after third molar surgery. J Oral Maxillofac surg 2005;63:pp.1162-1168.

. Omg KS, Seymour RA, Chen FG, Ho VCL. Pre-operative ketorolac has a pre-operative effect for postoperative third molar surgical pain. Int J Oral Maxillofac surg 2004;33:pp.771-776.

. Vickers MD, D.Flaherty D, Szekely SM, Read M, Yoshizumi J. Tramadol: pain relif by an opioid without depression of respiration. Anaesthesia 1992;47:pp.291-296.

. Rice ASC, Lloyd J, Miller CG, Bullingham E, O’sullivan GM. A double-blind study of the speed of onset of analgesia following intramuscular administration of ketorolac tromethamine in comparision to intramuscular morphine and placebo. Anaesthesia 1991;46:pp.541-544.

. Wong HY, L. Carpenter R,Kopacz DJ, Fragen RJ, Thompson

G, Maneatis TJ, et al. A randomized, double-blind evaluation of ketorolac tramethamine for postoperative analgesia in ambulatory surgery patients . Anaesthesiology 1993;78:pp.6-14.

. Walton GM,Road JP, Snowdon DT, Rickwood D, Ketorolac and diclofenac for postoperative pain relief following oral surgery . British Journal of Oral &Maxillofacial surgery 1993;31(3):pp.158-160.

. Claseman TS, Foley WL, Davis RD. A clinical evalution of the analgesic efficacy of preoperative administration of ketorolac and dexamethasone following surgical removal of third molar. Anesth prog 1998;45:pp.110-116.

. Campbell WI, Kendrick RW, Fee JPH. Balance pre-operative analgesia: does it work? A double-blind, controlled study in bilaterally symmetrical oral surgery. British Journal of Anaesthesia 1998;81:pp.727-730.

. Bouloux GF, Punnia-Moorthy A. Bupivacaine versus Lidocaine for third molar surgery: a double blind, randomized crossover study. J Oral Maxillofac Surg 1999;57:pp.510-514.

. Medve RA. Wang J, Karim R, Tramadol and acetaminophen tables of dental pain. Anesth prog 2001;48:pp.79-81.

. Altunkaya H, Ozer Y, Kargi E, Babuccu O. Comparision of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. British Journal of Anaesthesia 2003;90(3):pp.320-322.

. Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Demirel CB, Babucca O. The post-operative analgesic effect of tramadol when used as subcutaneous local anesthetic Anesth Analg 2004;99:pp.1461-64.

. Unlugenc H, Ozalevli M, Guler T, Isik G. Pre-emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery . British Journal of Anaesthesia 2003;9(2):pp.209-13.

. Zamiri B, Mousavizadeh K, Tajuddin M, Mohammadinezhad C, Aarabi AM. Comparision of ibuprofen celecoxib and tramadol in relief of pain after extraction of mandibular third molar teeth. Iranian Red Crescent Medical Journal 2009;11(4):pp.431-436.


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