Efficacy of Preoperative Administration of Paracetamol-codeine on Pain Following Impacted Mandibular Third Molar Surgery

Efficacy of Preoperative Administration of Paracetamol-codeine on Pain Following Impacted Mandibular Third Molar Surgery

Efficacy of Preoperative Administration of Paracetamol-codeine on Pain Following Impacted Mandibular Third Molar Surgery: a Randomized, Split-mouth, Placebo-controller, Double-blind Clinical Trial

Objectives: The aim of this study was to determine the effectiveness of preoperative administration of single-dose of paracetamol-codeine, in the relieving of acute post-operative pain after the surgical removal of an impacted mandibular third molar. Materials and Methods: The study cohort consisted of 32 Caucasian outpatients, giving a total of 64 bilateral symmetrical impacted mandibles. Patients were randomized in two experimental groups to receive a preoperative oral dose of paracetamol-codeine (analgesic group) or a placebo (placebo group) at the first and second surgeries. Study participants were asked to record pain intensity scores during the operation and the next 2 days, the time of the first request for rescue analgesic, and the total number of postoperative-supplement paracetamol-codeine tablets.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 1:00 pm during the operative day

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 6:00 pm during the operative day

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 11:00 pm during the operative day

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 2th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 8:00 am during the 2th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 2th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 1:00 pm during the 2th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 2th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 6:00 pm during the 2th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 2th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 11:00 pm during the 2th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 3th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 8:00 am during the 3th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 3th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 1:00 pm during the 3th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 3th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 6:00 pm during the 3th day after surgery

Pain measurement assessed with the Numerical Rating Scale-11 (NRS-11) during the 3th day after surgery.

The primary outcome of the study was the post-operative pain. Before surgery, patients were instructed to complete the Numerical Rating Scale-11 (NRS-11), which consisted of an interval scale ranging from 0 ("no pain") to 10 ("maximum pain")

All study participants were asked to record the pain intensity score at 11:00 pm during the 3th day after surgery

Number of patients using rescue therapy on the same day from the end of the surgery and during 2 days after operative days

Time elapsed from the end of surgery until the first intake of analgesic medication on the same day of the surgery

Total number of paracetamol-codeine tablets with the same formulation taken by the patient in relation to the pain symptoms

Inclusion Criteria: absence of systemic pathologies (ASA class I); non-smoker; not pregnant or lactating; good oral hygiene; no drug consumption for 10 days before the operation; bilateral impacted mandibular third molars with comparable position, depth and inclination; presence of the first and second molars; absence of painful symptoms and associated inflammatory or osteolytic pathologies in a radiographic examination; extraction difficulty index of >7 according to Pederson's scale and a degree of IV (complex procedures) on a modified version of Parant's scale. Exclusion Criteria: -

Cristalli MP, La Monaca G, De Angelis C, Pranno N, Annibali S. Efficacy of Preoperative Administration of Paracetamol-Codeine on Pain following Impacted Mandibular Third Molar Surgery: A Randomized, Split-Mouth, Placebo-Controlled, Double-Blind Clinical Trial. Pain Res Manag. 2017;2017:9246352. doi: 10.1155/2017/9246352. Epub 2017 Feb 23.