Comparison of Efficacy of Two Different Combination of Analgesics and Anti-Inflammatory Drugs in Post-Operative Pain Management Following Surgical Removal of Impacted Mandibular Third Molars
Author(s): Yandeti Srinivasulu*, Abdul Wahab and Dinesh Prabu
Abstract
Aim: The aim of the study was to evaluate the analgesic and anti-inflammatory efficacy of ketorolac plus tramadol as one group and ketorolac plus placebo as one group after surgical removal of mandibular third molar Materials And Methods: A prospective randomized study conducted with 100 patients that required removal of mesio angularly impacted mandibular third molar. The systematic statistical analysis was performed after the data collection was done. Patients were categorized into two groups (Group 1: ketorolac and tramadol, Group 2: ketorolac and placebo) in a crossover manner. Subjective and objective observations recorded that include age, gender, and pain score using visual analog scale . Each patient was evaluated using a visual analogue scale. Results: Pain intensity at the postoperative 1st, 6th, 12th, 24th hourly postoperative pain was measured. Mesioangular (75%) impacted teeth, 15% Horizontal (15%) impacted teeth, and 10% Distoangular (10%) impacted teeth were studied. Group A had a difficulty level of 7.4 and group B had a difficulty index of 7.8. Mean duration of surgery in Group A was 45 ± 6 minutes and in Group B was 48 ± 8 minutes. Acute pain relief was observed in the Ketorolac group within half an hour (min VAS was 2.68) but for a shorter duration of 4-5 hrs. The tramadol and ketorolac groups, however, had greater depth (min VAS score 1.65) and duration of analgesia (8-10 hrs). Complications such as nausea/vomiting (8%), drowsiness/sedation (6%), and upper gastric pain/acidity (8%), were more common in the tramadol group, while upper gastric pain/acidity was more common in the Ketorolac group. Conclusion: Tramadol induces delayed analgesia around 1 hour and reaches its maximum effect in 3 to 4 hours. Its analgesic effect lasts a longer duration for about 8 to 10 hours. In our study we concluded that an analgesic effect of ketorolac alone was lost for only 4 hours but the combination of ketorol and a tramadol was lost for 6 to 8 hours.