Comparison Between Dexamethasone and Ibuprofen for Postoperative Pain Prevention and Control After Surgical Implant Placement: A Double-Masked, Parallel-Group, Placebo-Controlled Randomized Clinical Trial

• Autores: Maha A. Bahammam, Rayyan A. Kayal, Dhafer S. Alasmari, Mai S. Attia, Laila A. Bahammam, Mona H. Hassan, Hamad A. Alzoman, Khalid Almas, Joao Paulo Steffens
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 88, Nº. 1, 2017, págs. 69-77
• Idioma: inglés
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• Resumen

  • Background: Postoperative pain is a potential adverse side effect of oral surgeries, and attempts should be made to prevent or minimize it. This study compares efficacy of preemptive ibuprofen and dexamethasone protocols for pain prevention or control after surgical implant placement.

    Methods: This prospective, double-masked, parallel-group, placebo-controlled, randomized clinical trial included 117 patients with planned dental implant placement. Patients were assigned to receive one of three different protocols: 1) 600 mg ibuprofen 1 hour before surgery and another 600 mg 6 hours after the first dose; 2) 4 mg dexamethasone 1 hour before surgery and another 4 mg 6 hours after the first dose; or 3) placebo. Rescue medication (1,000 mg acetaminophen) was made available to each patient, and they were instructed to take it as necessary. Pain intensity was evaluated via a 101-point numeric rating scale and a visual analog scale, and discomfort was evaluated using a four-point verbal rating scale hourly for the first 8 hours after surgery and three times daily for the following 3 days.

    Results: Ibuprofen and dexamethasone significantly reduced pain (Kruskal–Wallis; P <0.05) up to 3 days after surgery and discomfort (P <0.05) up to 2 days after surgery compared with placebo treatment. Both treatments reduced the number of painkillers taken and increased time before the first painkiller was taken (P <0.01).

    Conclusion: Steroidal dexamethasone is as effective as non-steroidal ibuprofen for preventing or controlling postoperative pain and discomfort after surgical implant placement.

    After dental implant placement, patients present with varying degrees of postoperative discomfort, pain, inflammation, and swelling as common consequences of surgery.1-5 Pain perception is a complex sensory and emotional experience that is highly subjective and varies substantially among individuals.6-8 Pain intensity is influenced by numerous parameters, including nature, duration, and extent of surgery9 and psychologic factors such as stress and anxiety.10 Surgical trauma to periodontal or peri-implant tissue results in tissue injury, causing release of inflammatory mediators. During the surgical procedure, pain can be effectively controlled by anesthetic agents.11 For postoperative pain, different protocols have been used to eliminate or at least minimize it.12-15 These protocols include use of systemic medications, such as steroidal or non-steroidal anti-inflammatory drugs (NSAIDs).4,16-19 Dexamethasone is a potent synthetic SAID that has significant benefit in controlling pain, swelling, and inflammation after third molar extraction surgeries,20,21 periodontal surgeries,4,16-19,22 and endodontic treatment.23,24 Dexamethasone acts by suppressing disruption of the arachidonic-acid cascade. Consequently production of prostaglandins, prostacyclins, thromboxanes, and leukotrienes is reduced,21,25-30 and production of inflammatory mediators is inhibited.13,21,25-30 Ibuprofen is an NSAID that is commonly used to reduce pain after oral and periodontal surgeries.31-34 It also has analgesic, antipyretic, and anti-inflammatory effects35,36 that are exerted via non-selective disruption of the cyclooxygenase enzyme, resulting in reductions in production of prostaglandins, prostacyclins, and thromboxanes. After tissue incision, phagocytes are activated, and production of proinflammatory cytokines is increased. Extracellular signaling proteins, chemokines, and other cytokines that induce cellular responses and affect cellular migration promote a state of hyperalgesia via sensitization of nociceptors, leading to reduction in the patient’s pain threshold.36 Despite importance of pain for both patient and dental practitioner, only some studies have evaluated prevention and control of pain and inflammation after dental implant placement.2,3,5,37 The aim of this study is to compare efficacy of dexamethasone and ibuprofen medication protocols for pain prevention and control after implant surgery.