Efficacy of oral diclofenac with or without codeine for pain control after invasive bilateral third molar extractions.
Postoperative pain and inflammation after oral surgery is mostly managed using non-steroidal anti-inflammatory drugs (NSAIDs). However, opioids combined with NSAIDs may improve pain management in patients, especially after traumatic oral surgery. Few studies have compared NSAIDs with and without opioid use after oral and maxillofacial surgery. This randomized, double-blind, cross-over study compared the clinical efficacy of either diclofenac (50mg) and codeine (50mg) or diclofenac alone (50mg) for the management of postoperative pain after invasive third molar surgery. Volunteers (n=46) who were scheduled to undergo the removal of symmetrically positioned lower third molars in two separate appointments were included. They reported significantly less postoperative pain at various time points within 24h after surgery and also consumed significantly less rescue medication (paracetamol (acetaminophen)) throughout the study when they took diclofenac combined with codeine than when they took only diclofenac. In conclusion, oral diclofenac with codeine was more effective for managing postoperative pain than diclofenac without codeine. It was expected that patients taking two pain medications after surgery would generally have less pain than when taking only one of the two medications. The prospective cross-over design of the present work makes this study distinct from many others.
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
P
P
Zupelari-Goncalves
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
G M
GM
Weckwerth
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
A M
AM
Calvo
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
L F
LF
Simoneti
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
T J
TJ
Dionisio
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
D T
DT
Brozoski
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
E A
EA
Torres
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
J R P
JRP
Lauris
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
F A C
FAC
Faria
Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil. Electronic address: cfsantos@fob.usp.br.
C F
CF
Santos
D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D003061:Codeine
NSAIDs; codeine; diclofenac; opioids; oral surgery; pain; third molar