Carllini Barroso Vicentini1, Juliana Cama Ramacciato2, Francisco Carlos Groppo3, Rubens Gonçalves Teixeira4, Rogério Heládio Lopes Motta5. 1. Oral and Maxillofacial Surgery Area, Instituto Tocantinense Presidente Antônio Carlos Porto (ITPAC PORTO), Porto Nacional, TO, Brazil. 2. Pharmacology, Anesthesiology and Therapeutics Area, São Leopoldo Mandic Institute and Research Center, Rua José Rocha Junqueira, 13, Campinas, 13045-755 SP, Brazil. 3. Department of Physiological Sciences, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil. 4. Oral and Maxillofacial Surgery Area, São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil. 5. Pharmacology, Anesthesiology and Therapeutics Area, São Leopoldo Mandic Institute and Research Center, Rua José Rocha Junqueira, 13, Campinas, 13045-755 SP, Brazil. rogerio.motta@slmandic.edu.br.
Abstract
PURPOSE: The aim of the present study was to compare two therapeutic protocols of dexamethasone for the prevention of postoperative swelling, pain, and other complications after the extraction of impacted third molars, in a prospective, randomized, crossover, double-blinded clinical trial. METHODS:Fifty patients with symmetrical impaction of third molars were randomly assigned to two different protocols of dexamethasone for each side. Patients underwent two sessions performed at a 21-day interval. In group 1, patients took 8 mg of dexamethasone orally 1 h before the procedure, and in group 2, 4 mg dexamethasone orally 1 h before and 24 h after the procedure. Surgery duration, volume of local anesthetics, surgical technique, and rescue medication were standardized. Postoperative pain was evaluated using a visual analog scale (VAS) at predefined times: before operation; immediately after; 1, 2, 4, and 12 h; and 1, 2, 3, and 7 days after operation. The patients were also instructed to take notes of the number of rescue medication tablets taken. Edema and mouth opening were clinically evaluated before surgery and in the postoperative period (second and seventh postoperative days). RESULTS: There were no significant differences between groups for VAS scales (p = 0.5048), but the use of rescue medication was significantly lower in group 1 (p = 0.006). None statistically significant differences (p > 0.05) were observed between groups in any of the time points for all measurements of edema. However, the mouth opening limitation (DIINC) was bigger (p = 0.0069) for group 1 at 2 days. CONCLUSION: Pre-emptive use of different dexamethasone regimens had a beneficial effect against pain, edema, and mouth opening limitation, especially when administered at an 8 mg concentration, which suggests that this protocol may also be efficient for more invasive surgery.
RCT Entities:
PURPOSE: The aim of the present study was to compare two therapeutic protocols of dexamethasone for the prevention of postoperative swelling, pain, and other complications after the extraction of impacted third molars, in a prospective, randomized, crossover, double-blinded clinical trial. METHODS: Fifty patients with symmetrical impaction of third molars were randomly assigned to two different protocols of dexamethasone for each side. Patients underwent two sessions performed at a 21-day interval. In group 1, patients took 8 mg of dexamethasone orally 1 h before the procedure, and in group 2, 4 mg dexamethasone orally 1 h before and 24 h after the procedure. Surgery duration, volume of local anesthetics, surgical technique, and rescue medication were standardized. Postoperative pain was evaluated using a visual analog scale (VAS) at predefined times: before operation; immediately after; 1, 2, 4, and 12 h; and 1, 2, 3, and 7 days after operation. The patients were also instructed to take notes of the number of rescue medication tablets taken. Edema and mouth opening were clinically evaluated before surgery and in the postoperative period (second and seventh postoperative days). RESULTS: There were no significant differences between groups for VAS scales (p = 0.5048), but the use of rescue medication was significantly lower in group 1 (p = 0.006). None statistically significant differences (p > 0.05) were observed between groups in any of the time points for all measurements of edema. However, the mouth opening limitation (DIINC) was bigger (p = 0.0069) for group 1 at 2 days. CONCLUSION: Pre-emptive use of different dexamethasone regimens had a beneficial effect against pain, edema, and mouth opening limitation, especially when administered at an 8 mg concentration, which suggests that this protocol may also be efficient for more invasive surgery.
Authors: Edmund Bailey; Helen V Worthington; Arjen van Wijk; Julian M Yates; Paul Coulthard; Zahid Afzal Journal: Cochrane Database Syst Rev Date: 2013-12-12
Authors: Seidu A Bello; Wasiu L Adeyemo; Babatunde O Bamgbose; Emeka V Obi; Ademola A Adeyinka Journal: Head Face Med Date: 2011-04-28 Impact factor: 2.151