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Current Therapeutic Research, Clinical and Experimental logoLink to Current Therapeutic Research, Clinical and Experimental
. 2005 Nov;66(6):541–551. doi: 10.1016/j.curtheres.2005.12.001

Comparison of preemptive analgesic effects of a single dose of nonopioid analgesics for pain management after ambulatory surgery: A prospective, randomized, single-blind studyin Turkish patients

Mesut Sener 1,*, Zafer Ozgur Pektas 2, Ismail Yilmaz 3, Ayda Turkoz 1, Sina Uckan 1, Asli Donmez 1, Gulnaz Arslan 1
PMCID: PMC3966011  PMID: 24678075

Abstract

Background:

Preemptive analgesia used for postsurgical pain management has been shown to reduce the requirements of postoperative analgesics.

Objective:

The aim of this study was to compare the preemptive analgesic effects of diflunisal, naproxen sodium, meloxicam, acetaminophen, and rofecoxin (no longer available in some markets) in patients undergoing ambulatory dental surgery and the need for postoperative pain management in these patients.

Methods:

This prospective, randomized, single-blind study was conducted at the Departments of Anesthesiology and Reanimation and Oral and Maxillofacial Surgery, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey. Turkish outpatients aged ≥ 16 years with American Society of Anesthesiologists physical status 1 (ie, healthy) and scheduled to undergo surgical extraction of an impacted third molar were enrolled. Patients were randomly assigned to receive diflunisal 500 mg, naproxen sodium 550 mg, meloxicam 7.5 mg, acetaminophen 500 mg, or rofecoxib 12.5 mg. All medications were administered orally 1 hour before surgery as preemptive analgesia and after surgery if needed, up to the maximum recommended dose. Surgery was performed with the patient under local anesthesia (articaine hydrochloride). Pain intensity was assessed using a 100-mm visual analog scale (VAS) (0 = none to 100 = worst possible pain) at 2, 4, 6, and 12 hours after ambulatory surgery. The use of additional analgesics was recorded for 24 hours using patient diaries. Postoperative adverse events were recorded using the diaries.

Results:

One hundred fifty patients (108 women, 42 men; mean [SE] age, 26.8 [0.6] years; 30 patients per group) had data available for analysis. Demographic data were similar between the 5 groups. No significant differences in mean VAS scores were found between the 5 groups at any time point. All mean VAS scores indicated minor pain. The rate of additional postoperative analgesics required was significantly lower in the diflunisal group compared with groups receiving naproxen sodium, meloxicam, acetaminophen, and rofecoxib (3 [10%] patients vs 11 [37%], 15 [50%], 15 [50%], and 14 [47%] patients, respectively; all, P < 0.05). Bleeding at the surgical site was reported in 2 patients each in the diflunisal, naproxen sodium, meloxicam, and acetaminophen groups, and in 1 patient in the rofecoxib group; the between-group differences were not significant. No significant differences in the prevalences of other adverse effects (eg, nausea, vomiting, allergy, gastrointestinal symptoms) were found between the 5 treatment groups.

Conclusions:

In the present study in patients undergoing third molar extraction, adequate preemptive analgesia, based on VAS scores, was found with all of the nonopioid analgesic agents used. Fewer patients required rescue medication with diflunisal. All 5 study drugs were similarly well tolerated.

Key words: preemptive analgesia, ambulatory surgery, NSAIDs

Full Text

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References

  • 1.Moiniche S., Kehlet H., Dahl J.B. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: The role of timing of analgesia. Anesthesiology. 2002;96:725–741. doi: 10.1097/00000542-200203000-00032. [DOI] [PubMed] [Google Scholar]
  • 2.Fletcher D., Zetlaoui P., Monin S. Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery. Pain. 1995;61:291–297. doi: 10.1016/0304-3959(94)00184-G. [DOI] [PubMed] [Google Scholar]
  • 3.White P.F. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg. 2002;94:577–585. doi: 10.1097/00000539-200203000-00019. [DOI] [PubMed] [Google Scholar]
  • 4.Watcha M.F., Issioui T., Klein K.W., White P.F. Costs and effectiveness of rofecoxib, celecoxib, and acetaminophen for preventing pain after ambulatory otolaryngologic surgery. Anesth Analg. 2003;96:987–994. doi: 10.1213/01.ANE.0000053255.93270.31. [DOI] [PubMed] [Google Scholar]
  • 5.Chang D.J., Desjardins P.J., Chen E. Comparison of the analgesic efficacy of rofecoxib and enteric-coated diclofenac sodium in the treatment of postoperative dental pain: A randomized, placebo-controlled clinical trial. Clin Ther. 2002;24:490–503. doi: 10.1016/s0149-2918(02)85126-8. [DOI] [PubMed] [Google Scholar]
  • 6.Chang D.J., Fricke J.R., Bird S.R. Rofecoxib versus codeine/acetaminophen in postoperative dental pain: A double-blind, randomized, placebo- and active comparatorcontrolled clinical trial. Clin Ther. 2001;23:1446–1455. doi: 10.1016/s0149-2918(01)80119-3. [DOI] [PubMed] [Google Scholar]
  • 7.Morrison B.W., Christensen S., Yuan W. Analgesic efficacy of the cyclooxygenase2 specific inhibitor rofecoxib in post-dental surgery pain: A randomized, controlled trial. Clin Ther. 1999;21:943–953. doi: 10.1016/S0149-2918(99)80016-2. [DOI] [PubMed] [Google Scholar]
  • 8.Malmstrom K., Daniels S., Kotey P. Comparison of rofecoxib and celecoxib, two cyclooxgenase-2 inhibitors, in postoperative dental pain: A randomized, placeboand active-comparator-controlled clinical trial. Clin Ther. 1999;21:1653–1663. doi: 10.1016/S0149-2918(99)80045-9. [DOI] [PubMed] [Google Scholar]
  • 9.Gustafsson I., Nystrom E., Quiding H. Effect of preoperative paracetamol on pain after oral surgery. Eur J Clin Pharmacol. 1983;24:63–65. doi: 10.1007/BF00613928. [DOI] [PubMed] [Google Scholar]
  • 10.Sisk A.L., Grover B.J. A comparison of preoperative and postoperative naproxen sodium for suppression of postoperative pain. J Oral Maxillofac Surg. 1990;48:674–678. doi: 10.1016/0278-2391(90)90048-7. [DOI] [PubMed] [Google Scholar]
  • 11.Sisk A.L., Mosley R.O., Martin R.P. Comparison of preoperative and postoperative diflunisal for suppression of postoperative pain. J Oral Maxillofac Surg. 1989;47:464–468. doi: 10.1016/0278-2391(89)90278-4. [DOI] [PubMed] [Google Scholar]
  • 12.Vogel R.I., Desjardins P.J., Major K.V. Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain. J Periodontol. 1992;63:914–918. doi: 10.1902/jop.1992.63.11.914. [DOI] [PubMed] [Google Scholar]
  • 13.Cheng T.T., Lai H.M., Chiu C.K., Chem Y.C. A single-blind, randomized, controlled trial to assess the efficacy and tolerability of rofecoxib, diclofenac sodium, and meloxicam in patients with acute gouty arthritis. Clin Ther. 2004;26:399–406. doi: 10.1016/s0149-2918(04)90035-5. [DOI] [PubMed] [Google Scholar]
  • 14.Nystrom E., Gustafsson I., Quiding H. The pain intensity at analgesic intake, and the efficacy of diflunisal in single doses and effervescent acetaminophen in single and repeated doses. Pharmacotherapy. 1988;8:201–219. doi: 10.1002/j.1875-9114.1988.tb04075.x. [DOI] [PubMed] [Google Scholar]
  • 15.Schnitzer T.J., Weaver A.L., Polis A.B., VACT-1 and VACT-2 (Protocols 106 and 150) Study Groups Efficacy of rofecoxib, celecoxib, and acetaminophen in patients with osteoarthritis of the knee. A combined analysis of the VACT studies. J Rheumatol. 2005;32:1093–1105. [PubMed] [Google Scholar]
  • 16.Van Hecken A., Schwartz J.I., Depre M. Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen, and naproxen on COX-2 versus COX-1 in healthy volunteers. J Clin Pharmacol. 2000;40:1109–1120. [PubMed] [Google Scholar]
  • 17.Eriksson L.O., Wahlin-Boll E., Liedholm H. Influence of chronic diflunisal treatment on the plasma levels, metabolism and excretion of indomethacin. Eur J Clin Pharmacol. 1989;37:7–15. doi: 10.1007/BF00609416. [DOI] [PubMed] [Google Scholar]
  • 18.Morgan G.J., Poland M., DeLapp R.E. Efficacy and safety of nabumetone versus diclofenac, naproxen, ibuprofen, and piroxicam in the elderly. Am J Med. 1993;95(Suppl 2A):19S–27S. doi: 10.1016/0002-9343(93)90392-3. [DOI] [PubMed] [Google Scholar]
  • 19.Furst D.E., Kolba K.S., Fleischmann R., Meloxicam Rheumatoid Arthritis Investigators Dose response and safety study of meloxicam up to 22.5 mg daily in rheumatoid arthritis: A 12 week multicenter, double blind, dose response study versus placebo and diclofenac. J Rheumatol. 2002;29:436–446. [PubMed] [Google Scholar]
  • 20.Chung F., Ritchie E., Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85:808–816. doi: 10.1097/00000539-199710000-00017. [published correction appears in Anesth Analg. 1997;85:986] [DOI] [PubMed] [Google Scholar]
  • 21.Reuben S.S., Bhopatkar S., Maciolek H. The preemptive analgesic effect of rofecoxib after ambulatory arthroscopic knee surgery. Anesth Analg. 2002;94:55–59. doi: 10.1097/00000539-200201000-00010. [DOI] [PubMed] [Google Scholar]
  • 22.Kehlet H., Dahl J.B. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048–1056. doi: 10.1213/00000539-199311000-00030. [DOI] [PubMed] [Google Scholar]
  • 23.Issioui T., Klein K.W., White P.F. Cost-efficacy of rofecoxib versus acetaminophen for preventing pain after ambulatory surgery. Anesthesiology. 2002;97:931–937. doi: 10.1097/00000542-200210000-00027. [DOI] [PubMed] [Google Scholar]
  • 24.Pavlin D.J., Horvath K.D., Pavlin E.G., Sima K. Preincisional treatment to prevent pain after ambulatory hernia surgery. Anesth Analg. 2003;97:1627–1632. doi: 10.1213/01.ANE.0000090150.65393.E9. [DOI] [PubMed] [Google Scholar]
  • 25.Recart A., Issioui T., White P.F. The efficacy of celecoxib premedication on postoperative pain and recovery times after ambulatory surgery: A dose-ranging study. Anesth Analg. 2003;96:1631–1635. doi: 10.1213/01.ANE.0000062526.60681.7B. [DOI] [PubMed] [Google Scholar]
  • 26.Pickering A.E., Bridge H.S., Nolan J., Stoddart P.A. Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth. 2002;88:72–77. doi: 10.1093/bja/88.1.72. [DOI] [PubMed] [Google Scholar]
  • 27.Huang J.J., Taguchi A., Hsu H. Preoperative oral rofecoxib does not decrease postoperative pain or morphine consumption in patients after radical prostatectomy: A prospective, randomized, double-blinded, placebo-controlled trial. J Clin Anesth. 2001;13:94–97. doi: 10.1016/s0952-8180(01)00219-7. [DOI] [PubMed] [Google Scholar]
  • 28.Steffen P., Krell M., Seeling W. Postoperative analgesia with rofecoxib. How effective is the preoperative application of a 25 mg dose [in German]? Schmerz. 2004;18:278–285. doi: 10.1007/s00482-003-0304-0. [DOI] [PubMed] [Google Scholar]
  • 29.Sculean A., Berakdar M., Donos N. The effect of postsurgical administration of a selective cyclo-oxygenase-2 inhibitor on the healing of intrabony defects following treatment with enamel matrix proteins. Clin Oral Investig. 2003;7:108–112. doi: 10.1007/s00784-003-0200-0. [DOI] [PubMed] [Google Scholar]
  • 30.Graham D.J., Campen D.H., Cheetham C. Risk of acute myocardial infarction and sudden cardiac death with use of COX-2 selective and non selective NSAIDs. Pharmacoepidemiol Drug Saf. 2004;13(Suppl 1):287–288. [Google Scholar]
  • 31.Solomon D.H., Schneeweiss S., Glynn R.J. Relationship between selective cyclooxygenase-2 inhibitors and acute myocardial infarction in older adults. Circulation. 2004;109:2068–2073. doi: 10.1161/01.CIR.0000127578.21885.3E. [DOI] [PubMed] [Google Scholar]
  • 32.Layton D., Heeley E., Hughes K., Shakir S.A. Comparison of the incidence rates of selected gastrointestinal events reported for patients prescribed rofecoxib and meloxicam in general practice in England using prescription-event monitoring data. Rheumatology (Oxford) 2003;42:622–631. doi: 10.1093/rheumatology/keg141. [DOI] [PubMed] [Google Scholar]
  • 33.Laporte J.R., Ibanez L., Vidal X. Upper gastrointestinal bleeding associated with the use of NSAIDs: Newer versus older agents. Drug Saf. 2004;27:411–420. doi: 10.2165/00002018-200427060-00005. [DOI] [PubMed] [Google Scholar]
  • 34.MacDonald T.M., Morant S.V., Goldstein L.J. Channelling bias and the incidence of gastrointestinal haemorrhage in users of meloxicam, coxibs, and older, non-specific non-steroidal anti-inflammatory drugs. Gut. 2003;52:1265–1270. doi: 10.1136/gut.52.9.1265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Scheiman J.M. Gastroduodenal safety of cyclooxygenase-2 inhibitors. Curr Pharm Des. 2003;9:2197–2206. doi: 10.2174/1381612033454018. [DOI] [PubMed] [Google Scholar]
  • 36.James M.W., Hawkey C.J. Assessment of non-steroidal anti-inflammatory drug (NSAID) damage in the human gastrointestinal tract. Br J Clin Pharmacol. 2003;56:146–155. doi: 10.1046/j.1365-2125.2003.01934.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Oviedo J.A., Wolfe M.M. Gastroprotection by coxibs: What do the celecoxib long-term arthritis safety study and the Vioxx gastrointestinal outcomes research trial tell us? Rheum Dis Clin North Am. 2003;29:769–788. doi: 10.1016/s0889-857x(03)00059-0. [DOI] [PubMed] [Google Scholar]
  • 38.Pajarola G., Riva C., Good M., Gratz K.W. Pain management after third molar extraction. Observations of the use of mefenamic acid and rofecoxib in the treatment of postoperative pain in the dental office [in French, German] Schweiz Monatsschr Zahnmed. 2003;113:887–896. [PubMed] [Google Scholar]

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