Effectiveness of Pre-emptive Analgesics on Postoperative Dental Pain

Objectives: Preliminary investigations have reported that pre-emptive analgesia administration may reduce post-extraction pain in adults. However, the subject has not been studied adequately in pediatric patients. This prospective, placebo controlled, randomized, double blind trial was planned to compare the efficacy of pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children. Methods: Forty-five children, aged 6-12 years, who needed mandibular primary molar tooth extraction were treated in pediatric dental clinics preceded by local anesthesia. Patients were assigned in a blind, random fashion to one of the three pre-treatment drug groups. All children received local anesthetic injections and analgesic drugs during the pre-operative period. A five-point face pain rating scale was used to evaluate pain reaction during the injection, extraction and postoperative period. Self-report scores were recorded when the local anesthesia was achieved in soft tissues (in 5 min) and before (between 5-15 min)/after (between 15 min-4 h) the extraction was completed. Parental report of their child's self-report of pain and use of analgesics during the immediate 5 h-, 6 h- and 24 h-postoperative period was elicited by telephone the day after the extraction procedure. Results: The usage of pre-emptive analgesics (ibuprofen or paracetamol) showed significantly different and lower pain scores compared to the placebo (p<0.05) irrespective of the age, weight, gender, and the number of the teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (p<0.05) compared to paracetamol at the 5 min, 15 min and 4 h periods. No serious adverse effects were reported. Conclusion: Pre-operative use of ibuprofen (30 min) and paracetamol (60 min) may provide a pre-emptive analgesic effect in pediatric patients who received adequate analgesia during mandibular primary molar tooth extraction.