Other Surgical Procedures, Pain
Conditions
Keywords
Ketofrofen, Omeprazole, Lower Third Molar, Oral Surgery
Brief summary
The control of pain, swelling and trismus in patients undergoing oral and maxillofacial surgery is frequently performed through the administration of non-steroidal anti-inflammatory drugs (NSAIDS). The present study aims to evaluate in a double blind, randomized and crossover manner the clinical efficacy of ketoprofen (immediate release - 100 mg) and ketoprofen in association with omeprazole (modified release - 200 mg ketoprofen with 20 mg omeprazole) in 50 patients aged 18 years or older that require removal of both lower third molars symmetrically positioned. After collection, data will be analyzed by means of graphs and tables to allow the appropriate analyses. Paired t-test will be used to compare the duration of surgeries. Nonparametric Wilcoxon test will be used for the analysis of rescue medication and postoperative pain parameters (visual analog scale). Data of mouth opening and swelling will be statistically analyzed through analysis of variance (ANOVA) followed by Tukey's test for multiple comparisons. Statistical significance will be set at 5%. Results will be presented as mean ± standard deviation of the mean.
Detailed description
Studies have shown that NSAIDS exert their therapeutic effect by the inhibition of cyclooxigenases (COX) 1 and 2, which determines the inhibition of prostaglandins production whose effects potentiate the action of many inflammatory mediators. The protocol for the administration of these formulations will involve the administration of a tablet of the immediate release product (100 mg) every 12 hours, and one capsule of the modified release product (200 mg ketoprofen with omeprazole) every 24 hours, during 4 days. The following parameters will be analyzed: 1. subjective postoperative pain evaluation, with the aid of a visual analogue scale, 2. mouth opening before the surgery, on the 2nd and 7th postoperative days (moment of suture removal), 3. beginning and duration of the surgery after anesthetic administration, 4. incidence, type and severity of adverse reactions, 5. total amount of rescue analgesic medication (paracetamol), 6. facial swelling measured on the 2nd and 7th postoperative days (in comparison with the measurements before the surgery).
Interventions
DRUGKetoprofen
Clinical efficacy of the Ketoprofen 100 mg was study after lower third molar surgery.
DRUGKetoprofen and Omeprazole
Clinical efficacy of the Ketoprofen 200 mg and Omeprazole 20 mg will be study after lower third molar surgery.
Sponsors
Fundação de Amparo à Pesquisa do Estado de São Paulo
Luis Fernando Simoneti
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* Need of lower third molar surgeries in similar positions
Exclusion criteria
* Presence of systemic diseases; * Presence of local inflammation and/or infection; * Any history of allergic reaction to local anesthetics, gastrointestinal bleeding or ulceration; * Cardiovascular, kidney or hepatic diseases; * Patients who are making use of antidepressants, diuretics or anticoagulants; * Asthma and allergy to aspirin, naproxen or any other nonsteroidal antiinflammatory drug; * Regular use of any nonsteroidal antiinflammatory drug, pregnancy or breast feeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diastolic blood pressure | During the surgical procedure | Median diastolic blood pressure to be verified and recorded at surgical moments previously described (injection of the first cartridge anesthesia, incision, mucoperiosteal detachment, osteotomies, tooth section, extraction, cleaning and suturing), carried out with the aid of a system for monitoring hemodynamic parameters |
| Quality of anesthesia during surgery based on a category 3point scale | During the surgical procedure | Quality of anesthesia during surgery based on a category 3point scale: 1) the patient reported no discomfort; 2) the patient reported discomfort, without the need to supplement the anesthesia; 3) reported some discomfort by the patient, requiring anesthesia complementation. Intraoral bleeding that will be evaluated by the surgeon according to a 3point scale (1: minimal, 2: normal and 3: Maximum), immediately after the following steps: injection of the first cartridge anesthesia, incision, mucoperiosteal detachment, osteotomies, tooth section, extraction, cleaning and suturing. |
| Intraoperative bleeding, rated by the surgeon according to a 3 point category rating scale | During the surgical procedure | Intraoperative bleeding, rated by the surgeon according to a 3 point category rating scale (1 minimal bleeding; 2 normal bleeding; 3 excessive bleeding) (SISK, 1986), immediately after the following steps: injection of the first cartridge of articaine, tissue incision, flap reflection, bone removal (when this procedure was necessary), tooth extraction, cleaning of the operated site, and completion of suturing. |
| Heart rate | During the surgical procedure | Median heart rate to be verified and recorded surgical at moments described above, carried out with the aid of a system for monitoring hemodynamic parameters |
| Oxygen saturation | During the surgical procedure | Median oxygen saturation recorded at surgical moments described above, carried out with the aid of a system for monitoring hemodynamic parameters. |
| Systolic blood pressure | During the surgical procedure | Median systolic blood pressure to be verified and recorded at surgical moments previously described (injection of the first cartridge anesthesia, incision, mucoperiosteal detachment, osteotomies, tooth section, extraction, cleaning and suturing), carried out with the aid of a system for monitoring hemodynamic parameters |
| Subjective evaluation of postsurgical pain | Fourth postoperative hour | Subjective evaluation of postsurgical pain, which was annotated by the volunteer, a Visual Analogue Scale (VAS, 0-100 mm) at the fourth postoperative hour. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Onset and duration of surgery after administration of anesthetic | During the surgery | Will only be considered those surgeries in which there is no long time gap between the two surgical times. |
| Incidence, type and severity of adverse reactions | Seventh postoperative day | Will be considered as adverse reactions: gastrointestinal irritation, nausea, vomiting, bleeding, allergy, headache, dizziness, drowsiness or any other type of reaction presented after surgery. |
| Total amount of rescue medication | Seventh postoperative day | The total amount of rescue medication that was used by the patient during the postoperative period (paracetamol 750 mg) will be analyzed |
| Measurement the facial edema distance between the lateral corner of the eye and the gonion, away from the tragus corner of the mouth and away from the tragus to the soft tissue of pogonion. | On the second day after surgery and on the seventh day after surgery | It will apply the method used by Ustun et al. (2003), which takes into account the sum of the following measures (obtained with flexible tape measure): A) distance between the lateral corner of the eye and the gonion, B) away from the tragus corner of the mouth and C) away from the tragus to the soft tissue of pogonion. Preoperative sum of three measures will be considered as the baseline that way. The difference between the values obtained in the postoperative period and baseline indicate the facial edema in the 2nd and 7th days. |
| Mouth opening (mm) between the mesial-incisal corners of the upper and lower right central incisors at maximum opening of the jaws | Second and Seventh postoperative days | Mouth opening (mm) between the mesial-incisal corners of the upper and lower right central incisors at maximum opening of the jaws was measured and recorded before the surgery and during the second and seventh postoperative days. |
Countries
Brazil
Outcome results
None listed