In: Dental treatment12 Oct 2009
Preemptive analgesia is the assumption that an analgesic given before noxious stimulus has effects that long outlasts the presence of the analgesic in the body. The clinical implication would be more effective pain management, reducing postoperative pain and analgesic requirements.
There is convincing evidence in the general surgery model that opioids have a preemptive effect. However, the evidence for a preemptive effect of NSAIDs (*Generic Voltarol diclofenac is in a group of drugs called nonsteroidal anti-inflammatory drugs) is conflicting. To date, the only RCT in the third molar surgical model did not support that NSAIDs (Cytotec tabletes used to induce labor and as an abortifacient) have any preemptive effect. One hundred milligrams of diclofenac sodium was tested for any preemptive effect in 21 patients in a randomized, crossover trial. No significant difference was found in the pain scores. However, this negative study did not provide any statistical information on the confidence interval or the power estimation. The sample size may not have been large enough to detect significant differences. The results from a previous study done by Campbell et al indicated that at least 30 patients would be needed in this surgical model in order to detect a significant difference in pain. This is based on the assumption that a difference of 10 mm in the visual analogue scale is clinically significant between the 2 sides in each patient, with a type I alpha error of .05 and a type II beta error of .01.
By contrast, it has been shown that IV 60 mg of ke torolac has a preemptive effect in an RCT of 60 total hip replacement surgery patients. However, 1 confounding factor in this study was a large disparity between the number of male and female subjects, with more women in the control group. The authors also admitted that no information was available concerning the preoperative level of pain and analgesic consumption in the patients. These factors may have introduced bias into this study.
The evidence for the preemptive effect of NSAIDs (Mobic canadian is used for treating rheumatoid arthritis, osteoarthritis, and juvenile arthritis) is conflicting. However, the consensus of experts recommends that it is advantageous to give NSAIDs preemptively to prevent pain (level III evidence). Administration of the NSAIDs 1-2 hours prior to pain onset allows for absorption and distribution of the drug to establish effective blood levels at the site of action, rather than having the patient experience pain and administer the NSAID (Generic Celecoxib is a Non-Steroidal Anti-Inflammatory Drug) after onset. There may be advantages in considering the use of COX-2 inhibitors as a medication of choice in preemptive analgesia compared with COX-1 inhibitors because of the minimal thromboxane effects. In theory, this will cause minimal postoperative bleeding problems when compared with COX-1 inhibitors, particularly when multiple dental extractions or more major oral surgery is to be done. A recent study reported that a 10-day administration of rofecoxib had no effect on the antiplatelet activity of low-dose aspirin, as measured by serum thromboxane B2 activity and platelet aggregation. This suggests that rofecoxib could be safely used in patients taking prophylactic aspirin without the additional risks of bleeding problems.
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.