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Capstone

Does preemptive NSAID administration in patients undergoing surgical tooth extraction decrease postoperative narcotic use and improve clinical outcome?

1 August 2002

Abstract

Millions of individuals undergo elective or essential surgery every year. While outcomes differ between different types of surgery, one thing remains constant: pain. Pain decreases the probability of a timely favorable outcome. It may be caused by trauma and its byproducts prior to the surgery or by trauma incurred by surgery. While it is impossible to prevent traumatic events and injury in all cases, there are situations in which trauma can be controlled and averted. The setting where necessary trauma can be best regulated is in the operating room, where skilled surgeons and staff work to repair the human body and decrease mortal suffering. This is a double blind, randomized placebo controlled study focused on the use of preemptive nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease the byproducts of trauma caused by surgery, hypothesizing that preemptive NSAID use will decrease pain and recovery time. This study was carried out in two phases. Phase I involved patients (N=26) from one family dentist and one oral surgeon who underwent surgical tooth extraction under local anesthesia between Feb 1,2002 and May 28,2002. Patients were randomized and the treatment group (N=13) received 800 mg of ibuprofen one hour (+/-1 hour) prior to surgery. The number of teeth extracted, the presence of infection, complications, and the amount and type of local anesthetic used were recorded by the surgical assistants and each patient filled out a survey at their postop visit that indicated recovery time and daily pain levels. Phase II involved the patients (N=174) of an oral surgeon who underwent surgical tooth extraction under general anesthesia between Feb 1, 2002 and May 28, 2003. Patients were randomized and the treatment group (N=69) received 30 mg of ketorolac 15 minutes (+/- 15 minutes) prior to surgery. All patients received 8 mg of dexamethasone prior to surgery. The number of teeth extracted, presence of infection, difficulty of extraction, complications, and the amount and type of general and local anesthetics were recorded by the surgical assistants and each 'patient filled out a survey at their postoperative visit that indicated recovery time and daily pain levels. All variables were compared using X2 test for bivariate analysis and it was found that preemptive NSAID use was significantly better than placebo at decreasing postoperative pain levels and recovery time in Phase I. In Phase II, it was demonstrated that the use of ketorolac and dexamethasone was not significantly superior to dexamethasone alone at decreasing postoperative pain levels or recovery time.


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