Pain is the most common symptom bringingpatients to dental office 1. Despite its prevalence it’s verychallenging to manage pain in day today practice. Often the dental treatmentalone can provide a great relief from pain such as immediate reduction of painfollowing an incision and drainage of an abscess or the relief that can beaccomplished by removal of an affected tooth.
So the next step will be towardsmanaging the post-operative pain.Surgical removal of third molar is one of thecommon procedures done by oral and maxillofacial surgeons, this procedureinvolves incisional and inflammatory injuries that results in pain, swelling, trismusin the post-operative period 2. The first 12 hours followingremoval of the tooth is considered as most unpleasant experience3. This can be reduced by use ofpre-emptive analgesia that is started before the beginning of the surgery. It has a great impact on the patient’s pain perception4, 5.During the perioperative period, there is aflow of nociceptive signals from the operating site. It has a dual phasecharacter, the initial phase or the first phase results from injuries producedby the surgical procedure, the second phase of nociceptive stimulation is dueto the inflammatory responses associated with the tissue injury.
The peripheral tissue injury provokes twokinds of modification in the responsiveness of the nervous system: Peripheralsensitisation, a reduction in the threshold of nociceptor afferent peripheralterminals and Central sensitisation, an actively dependant increase in theexcitability of spinal neurons. Together these changes contribute to postinjury pain hypersensitivity state found post operatively. This manifest as increase in response tonoxious stimuli and a decrease in pain threshold both at the site of injury andin the surrounding uninjured tissue. The sensory signals generated by thetissue damage during the surgery can produce an increased excitability in thecentral nervous system.
The role of Preemptive analgesia is that it blocks theinitiation of central sensitisation evoked by incisional and inflammatoryinjuries occurring during surgery and in initial post-operative period.678 It leads to effective reduction in the development of Peripheraland Central sensitisation – the reason for primary and secondary hyperalgesia.9101112Primary hyperalgesia refers to pain sensitivity in thesurgical site, whereas secondary hyperalgesia refers to pain sensitivity in thesurrounding tissues.
Thus successful post-operative pain controlcan be achieved by · Blockingthe beginning of neural cascade which results to increased sensitivity producedby noxious stimuli.6 7 8 13· Efficientanalgesic agent before the onset of the unpleasant stimulus to prevent centralsensitisation and preventing painless sensation to be seen as pain (allodynia).678 13 This idea of preventing pain was firstintroduced by Crile in 1913, which was further developed by Wall and Woolf.
They suggested that simply changing the timing of treatment can have bettereffects on post-operative pain.Various pre-emptive agents can be used foreffective pain management among them are NSAID’S. 14 15 16 17 The Main mechanism of action of NSAIDsare inhibition on cyclooxygenase activity as a result there is inhibition ofprostaglandins which has a proinflammatory effect.We have compared Aceclofenac 100 mg andPiroxicam 20 mg given orally one hour before the surgery among patientsundergoing surgical removal of impacted third molar.With the help of our prospective randomiseddouble blind study we have compared the efficacy of Aceclofenac and Piroxicamas pre-emptive analgesic for preventing postoperative pain after third molarsurgery.Materials and MethodsStudylocation: The study was conducted among patientsreporting to the Department of Oral and Maxillofacial Surgery for surgicalremoval of impacted third in a private Dental College, Chennai, Tamil Nadu, India.StudyGroups:The study was conducted among 50 subjects,who were randomly grouped into two groups- Aceclofenac group (A) and Piroxicamgroup (B).The Aceclofenac group (A) comprised of 25individuals, who were given Aceclofenac 100mg preoperatively 1 hour before theprocedure.
The Piroxicam group (B) comprised of 25individuals, who were given Piroxicam 25mg preoperatively 1 hour before theprocedureAll the subjects were explained about thisstudy in detail and the possible complications in the study and all thepatients were given informed consent. Inclusioncriteria:1. Healthy subjects without any systemicdisease were included in this study.2.
Subjects not under any analgesics or othermedications 24 hours prior to surgery.3. Subjects not allergic to any medicament.
4. Patients who can report for post-operativereview.Exclusioncriteria:1. Subjects with systemic disease, pregnancyor lactation were excluded.2.
Subjects reported with pericoronitis orpericoronal abscess were excluded from the study.3. Subjects who have taken any analgesics 24hours prior to surgery were excluded.
4. Subjects allergic to any medicament wereexcluded from the study.The patient, the operating surgeon were allblinded during the study process, all the patients were evaluated by one principalinvestigator.Each patient was assessed before theprocedure for any pain, if they had pain their score was recorded in the VisualAnalogue Scale, followed by 24 hours post operatively followed by 3rdand 5th day for pain.
Patient’s mouth opening was assessed beforethe procedure, followed by 3rdand 5th day.Criteria for measurement: Pain measurement was done using Visual AnalogueScale (VAS) on a scale of 0 to 10.