InquiryPreemptive analgesia
Section snippets
Background
Removing the mandibular third molar surgically is often associated with postoperative pain, swelling, and trismus, which increase the patient's suffering and anxiety and can disrupt the homeostasis of the circulatory and endocrine systems. Wound healing is also adversely affected by postoperative pain, so effective and fast-acting analgesia is desirable. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used, but if severe pain develops, it is difficult to manage it with analgesics.
Basis for Preemptive Analgesia
Stimuli that cause tissue damage can produce hypersensitivity, hyperalgesia, allodynia, and abnormal paresthesia that lead to the onset of pain. Peripheral sensitization associated with the lower threshold of nociceptors and central sensitization linked to increased central nervous system excitability are believed to produce this. These sensory disturbances are also believed to produce intractable postoperative pain. When central sensitization is in place, analgesics tend to be ineffective.
Effectiveness for Postoperative Pain
Studies confirm that preemptive analgesia can positively affect the pain issue for thoracic, abdominal, and orthopedic surgery. NSAIDs may be applied presurgically, or ketamine given presurgically may be combined with peritoneal infusion of long-acting local anesthetics through abdominal incisions. In contrast, few studies have evaluated the effects of preemptive analgesia in oral surgery other than tooth extraction, and the study results are not consistent. It has been shown that preoperative
Third Molar Surgery Uses
The recent studies of preemptive analgesia for mandibular third molar surgery pain are all randomized, prospective, and placebo-controlled. The agents used were mostly acid NSAIDs. Flurbiprofen and ketorolac were given intravenously; diclofenac, talniflumate, ibuprofen, zaltoprofen, loxoprofen, and ketoprofen were administered orally. The selective COX-2 inhibitors rofecoxib and celecoxib, acetaminophen with weak COX inhibition, and methadone were also investigated. The drugs were administered
Discussion
Thoracic, abdominal, and orthopedic surgery has demonstrated the effectiveness of preemptive analgesia to manage central sensitization caused by surgical tissue damage. Reports of central sensitization inhibition in the head and neck region are rarely seen. However, chemical mediators associated with surgical inflammation stimulate local nociceptors and induce peripheral sensitization. The inflammatory reaction may also provide sensory signals that could induce central sensitization. If there
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Yamaguchi A, Sano K: Effectiveness of preemptive analgesia on postoperative pain following third molar surgery: Review of literatures. Japan Dent Sci Rev 49:131-138, 2013
Reprints available from A Yamaguchi; e-mail: [email protected]