Comparative Study of the Pre-emptive Analgesic Effects of Nonsteroidal Anti-inflammatory Drugs Having Different Mechanisms of Action, for Pain Associated with Extraction of Impacted Wisdom Teeth

- Comparison of the Drugs Among Selective Cyclooxygenase-2 Inhibitor with/without Anti-bradykinin Effect and Cyclooxygenase-1, -2 Inhibitor -

Abstract

Backgrounds : Pre-emptive analgesia is gaining support as a method of postoperative pain management. The present study aims to compare the pre-emptive analgesic effects of nonsteroidal anti-inflammatory drugs (NSAIDs) having different mechanisms of action, for relief of pain associated with extraction of impacted wisdom teeth. Methods : Thirty-three patients scheduled for extraction of impacted wisdom teeth were randomly administered one tablet each of any one of the following NSAIDs : zaltoprofen (selective cyclooxygenase (COX)-2 inhibitor with anti-bradykinin effect), loxoprofen sodium (COX-1 and -2 inhibitor) or etodolac (selective COX-2 inhibitor), 1 hour prior to the scheduled extraction. Postoperative pain was assessed on the basis of pain scores on the visual analogue scale (VAS), 6 hours after administration of the analgesic tablet. Results : Postoperative analgesia was not required in 2 of the 9 zaltoprofen patients and 3 of the 10 patients who received loxoprofen sodium.In addition, the VAS pain scores of patients in the zaltoprofen and loxoprofen sodium groups were significantly lower than those in patients who received etodolac. Conclusions : These results suggest that inhibition of COX-2 alone is insufficient for pre-emptive analgesia, NSAIDs acting on bradykinin, and both COX-1 and -2 being more effective pre-emptive analgesics for postoperative pain after extraction of impacted wisdom teeth.