title: Efficacy of Ketamine as an Adjunct to Local Anesthesia in the Surgical Removal of Impacted Mandibular Third Molars - A Split Mouth Prospective Controlled Clinical Study.
abstract: BACKGROUND
  The removal of impacted teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Reduction of discomfort post-operatively and efficient local anesthesia are imperative for success in surgical practice. At sub-anesthetic doses, ketamine has a noticeable analgesic action, which can be used to supplement local anesthesia with minimal side effects.
  
  
  OBJECTIVE
  To assess the efficacy of low-dose ketamine as an adjunct to local anesthesia in the management of pain, swelling and trismus after surgical removal of impacted mandibular third molars.
  
  
  METHODS
  Twenty five patients with bilaterally symmetrical impacted mandibular third molars requiring surgical removal under local anesthesia were selected for the controlled clinical study. The third molar sites of all patients enrolled in the trial were randomly assigned into 2 groups: Local Anesthesia (Lignocaine) Alone [LAA] and Local Anesthesia plus ketamine [LAK]. 5ml of local anesthetic (Lignocaine Hydrochloride 2% with epinephrine 1:100,000) was injected in the 'LAA' group while the 'LAK' group received 5ml of local anesthetic plus 0.2mg/kg ketamine. Patients were blinded to the solution used and the operator recorded the group (LAA or LAK) and the respective site (Right or Left) for analysis. Bilaterally symmetrical impacted mandibular molars were removed at an interval of 15 days.
  
  
  RESULTS
  Facial swelling on post-operative days was significantly lower in the LAK group than in the LAA group (p<0.05). The pain scores on the VAS were significantly higher in the LAA group than in the LAK group (p<0.05).
  
  
  CONCLUSIONS
  The role of ketamine in low doses as an analgesic and anti-inflammatory is evident in our study. The combination of a local anesthetic and sub-anesthetic doses of ketamine injected for surgical removal of impacted third molars provides good local anesthesia while alleviating post-operative sequelae for the patient by providing a degree of post-operative analgesia with less swelling.
authors.affiliation: Ex-Postgraduate, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital , Pune, Maharasthra, India .
authors.forename: Anand
authors.initials: A
authors.lastname: Shah
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital , Pune, Maharasthra, India .
authors.forename: Rajshekhar
authors.initials: R
authors.lastname: Halli
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital , Pune, Maharasthra, India .
authors.forename: Yash
authors.initials: Y
authors.lastname: Merchant
authors.affiliation: Professor and Head of Department, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital , Pune, Maharasthra, India .
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kshirsagar
authors.affiliation: Ex-Postgraduate, Department of Periodontology, Bharati Vidyapeeth Deemed University Dental College and Hospital , Pune, Maharasthra, India .
authors.forename: Jyotsana
authors.initials: J
authors.lastname: Khurana
keywords: Impacted teeth; Post-operative pain; Swelling; Trismus