Pre-emptive Analgesic Efficacy of Injected Ketorolac in Comparison to Other Agents for Third Molar Surgical Removal: a Systematic Review

Overview

Journal J Dent Anesth Pain Med

Date 2021 Feb 15

PMID 33585680

Citations 3

Authors

Sunnypriyatham Tirupathi

Srinitya Rajasekhar

Sardhar Singh Maloth

Aishwarya Arya

Pushpalatha Tummalakomma

Rama Brahman Lanke

Affiliations

Soon will be listed here.

Abstract

This study aimed to evaluate and compare the pre-emptive analgesic efficacy of injected ketorolac to that of other agents for impacted third molar surgical removal in a healthy population. PubMed, Ovid SP, Cochrane databases were filtered from 1980 to July 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria independently by reviewers. Studies that compared pre-emptive intramuscular or intravenous administration of ketorolac to other agents were evaluated. The outcomes sought were self-reported postoperative pain (patient-perceived pain), median duration for rescue analgesic medication, total number of analgesics consumed in the recovery period, and global assessment (overall patient satisfaction) after the recovery period. Six studies were included in the final evaluation. The outcome of pain perception and the number of analgesics taken were significantly lower in the ketorolac group (intramuscular or intravenous) in most of the studies (n=5) than in the group of other drugs. The mean time for rescue analgesia intake was higher for the ketorolac group, and global assessment scores were also better in the ketorolac group. Although the included studies show significantly better outcomes such as postoperative pain, median time taken for rescue medication, total number of analgesics taken, and overall patient satisfaction with injected ketorolac group in comparison to injected diclofenac, dexamethasone, and tramadol, definitive conclusions cannot be made regarding the superiority of injected Ketorolac as a pre-emptive agent. A greater number of randomized control trials with a proper protocol are needed to make definitive conclusions.

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References

Ilhan O, Agacayak K, Gulsun B, Koparal M, Gunes N . A comparison of the effects of methylprednisolone and tenoxicam on pain, edema, and trismus after impacted lower third molar extraction. Med Sci Monit. 2014; 20:147-52. PMC: 3915002. DOI: 10.12659/MSM.890239. View

Isiordia-Espinoza M, Pozos-Guillen A, Martinez-Rider R, Herrera-Abarca J, Perez-Urizar J . Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery. Med Oral Patol Oral Cir Bucal. 2011; 16(6):e776-80. DOI: 10.4317/medoral.16854. View

Pektas Z, Sener M, Bayram B, Eroglu T, Bozdogan N, Donmez A . A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for postoperative pain management: a prospective, randomized, single-blind, crossover study. Int J Oral Maxillofac Surg. 2006; 36(2):123-7. DOI: 10.1016/j.ijom.2006.10.005. View

Claseman T, Foley W, Davis R, Morrison J, Palmore C, Murchison D . A clinical evaluation of the analgesic efficacy of preoperative administration of ketorolac and dexamethasone following surgical removal of third molars. Anesth Prog. 2009; 45(3):110-6. PMC: 2148954. View

Brignardello-Petersen R . Preemptive submucosal diclofenac may reduce postoperative pain up to 6 hours after surgical mandibular third-molar extraction but may increase adverse effects. J Am Dent Assoc. 2018; 149(6):e92. DOI: 10.1016/j.adaj.2018.01.016. View

Wright G, Smith A . Intra-muscular ketorolac administered as a supplemental analgesic for removal of impacted third molar teeth: a prospective study. Aust Dent J. 2002; 47(1):41-4. DOI: 10.1111/j.1834-7819.2002.tb00302.x. View

Cetira Filho E, Carvalho F, Barros Silva P, Barbosa D, Pereira K, Ribeiro T . Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials. J Craniomaxillofac Surg. 2020; 48(3):293-307. DOI: 10.1016/j.jcms.2020.01.016. View

Morse Z, Tump A, Kevelham E . Ibuprofen as a pre-emptive analgesic is as effective as rofecoxib for mandibular third molar surgery. Odontology. 2006; 94(1):59-63. DOI: 10.1007/s10266-006-0062-4. View

Shah A, Kumar K, Rai K, Rajesh Kumar B . Comparative evaluation of pre-emptive analgesic efficacy of intramuscular ketorolac versus tramadol following third molar surgery. J Maxillofac Oral Surg. 2014; 12(2):197-202. PMC: 3682004. DOI: 10.1007/s12663-012-0420-4. View

10.

Santos J, Ferreira da Silva L, de Santana Santos T, Junior L, de Assuncao Oliveira A, Brandao J . Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery. J Craniomaxillofac Surg. 2012; 40(8):694-700. DOI: 10.1016/j.jcms.2012.01.001. View

11.

Isiordia-Espinoza M, Sanchez-Prieto M, Tobias-Azua F, Reyes-Garcia J, Granados-Soto V . Pre-emptive analgesia with the combination of tramadol plus meloxicam for third molar surgery: a pilot study. Br J Oral Maxillofac Surg. 2012; 50(7):673-7. DOI: 10.1016/j.bjoms.2011.12.003. View

12.

Pandit M, Godhi S, Lall A . Preoperative intravenous tramadol versus diclofenac for preventing postoperative pain after third molar surgery: a comparative study. J Maxillofac Oral Surg. 2012; 10(4):306-9. PMC: 3267914. DOI: 10.1007/s12663-011-0250-9. View

13.

Mishra H, Khan F . A double-blind, placebo-controlled randomized comparison of pre and postoperative administration of ketorolac and tramadol for dental extraction pain. J Anaesthesiol Clin Pharmacol. 2012; 28(2):221-5. PMC: 3339729. DOI: 10.4103/0970-9185.94892. View

14.

Paiva-Oliveira J, Oliveira Bastos P, Cury Pontes E, da Silva J, Delgado J, Oshiro-Filho N . Comparison of the anti-inflammatory effect of dexamethasone and ketorolac in the extractions of third molars. Oral Maxillofac Surg. 2015; 20(2):123-33. DOI: 10.1007/s10006-015-0533-2. View

15.

Demirbas A, Karakaya M, Bilge S, Gunay Canpolat D, Kutuk N, Alkan A . Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study. J Oral Maxillofac Surg. 2019; 77(10):1990-1997. DOI: 10.1016/j.joms.2019.04.019. View

16.

Gutta R, Koehn C, James L . Does ketorolac have a preemptive analgesic effect? A randomized, double-blind, control study. J Oral Maxillofac Surg. 2013; 71(12):2029-34. DOI: 10.1016/j.joms.2013.06.220. View

17.

Eroglu C, Durmus E, Kiresi D . Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: A pilot study. Med Oral Patol Oral Cir Bucal. 2014; 19(6):e622-7. PMC: 4259381. DOI: 10.4317/medoral.19835. View

18.

Eriksson L, Tegelberg A . Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery. Oral Maxillofac Surg. 2015; 19(4):353-9. DOI: 10.1007/s10006-015-0502-9. View

19.

Araujo F, de Santana Santos T, de Morais H, Laureano Filho J, de Oliveira E Silva E, Vasconcellos R . Comparative analysis of preemptive analgesic effect of tramadol chlorhydrate and nimesulide following third molar surgery. J Craniomaxillofac Surg. 2012; 40(8):e346-9. DOI: 10.1016/j.jcms.2012.01.018. View

20.

Walton G, Rood J, Snowdon A, Rickwood D . Ketorolac and diclofenac for postoperative pain relief following oral surgery. Br J Oral Maxillofac Surg. 1993; 31(3):158-60. DOI: 10.1016/0266-4356(93)90115-d. View