title: A prospective study to assess the levels of interleukin-6 following administration of diclofenac, ketorolac and tramadol after surgical removal of lower third molars.
abstract: BACKGROUND
  The surgical removal of impacted third molars involves, trauma to soft and bony tissue and can result in considerable pain, swelling, and trismus. The greater the amount of tissue injury the greater is the amount of inflammation in the perisurgical region. Interleukin-6 (IL-6) is both a pro inflammatory and anti-inflammatory cytokine. It is secreted by T cells and macrophages to stimulate the immune response. IL-6 is also an early marker of tissue damage. In addition to NSAIDs, corticosteroids, opioids also have immunomodulatory effects.
  
  
  OBJECTIVE
  To evaluate the changes in serum IL-6 levels following surgical removal of third molars under local anaesthesia after administration of two NSAIDs diclofenac and ketorolac and opioid tramadol post operatively.
  
  
  METHODS
  Patients undergoing surgical removal of impacted mandibular third molar teeth were randomly assigned to three groups. Each group received one of the three analgesics viz diclofenac 50 mg, ketorolac 10 mg and tramadol 50 mg. The mean levels of IL-6 was then estimated by ELISA.
  
  
  RESULTS
  The results of our study showed that all three drugs i.e. diclofenac, ketorolac and tramadol have properties which can downregulate the production of IL-6 in response to surgical trauma.
  
  
  CONCLUSIONS
  It is of clinical significance that the suppression of IL-6 values occurs in tramadol group closely following the diclofenac group. Even though the drug ketorolac suppresses the IL-6 levels similar to diclofenac initially but after 7 days tramadol and ketorolac showed similarities in suppression of IL-6 expression which is less compared to diclofenac group.
authors.affiliation: New Delhi, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Oral and Maxillofacial Surgery, ITS-CDSR, Delhi-Meerut Road, Murad Nagar, Ghaziabad, 201206 India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rastogi
authors.affiliation: IDST, Kadrabad, Modinagar, India.
authors.forename: Mansi
authors.initials: M
authors.lastname: Bansal
authors.affiliation: Department of Oral and Maxillofacial Surgery, ITS-CDSR, Delhi-Meerut Road, Murad Nagar, Ghaziabad, 201206 India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Singh
authors.affiliation: Shree Bankey Bihari Dental College and Research Center, Masuri, Ghaziabad, India.
authors.forename: Sumita G
authors.initials: SG
authors.lastname: Nishad
authors.affiliation: Department of Oral and Maxillofacial Surgery, ITS-CDSR, Delhi-Meerut Road, Murad Nagar, Ghaziabad, 201206 India.
authors.forename: Mahendra P
authors.initials: MP
authors.lastname: Reddy
authors.affiliation: Department of Oral and Maxillofacial Surgery, ITS-CDSR, Delhi-Meerut Road, Murad Nagar, Ghaziabad, 201206 India.
authors.forename: Kumar Rakshak
authors.initials: KR
authors.lastname: Anand
authors.affiliation: New Delhi, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Shree Bankey Bihari Dental College and Research Center, Masuri, Ghaziabad, India.
authors.forename: Muhamad Nishad
authors.initials: MN
authors.lastname: Thayath
keywords: Diclofenac; Interleukin-6; Ketorolac; Third molar surgery; Tramadol