Rofecoxib vs Ibuprofen Preemptively for Mandibular Third Molar Surgery

Objectives: To compare the pre-emptive analgesic effect of Rofecoxib a COX-2 inhibitor with a more traditional and commonly used analgesic Ibuprofen for mandibular third molar surgery. Methods: Forty-eight patients presenting for mandibular third molar surgery in an outpatient setting were divided randomly into three groups to receive 50mg Rofecoxib or 400mg Ibuprofen or placebo one hour prior to surgery. A dose of 1000 mg of Paracetamol was offered as rescue medication. Participants recorded their pain intensity on a 10cm visual analogue scale one hour before and just prior to surgery and every thirty minutes for six hours following surgery. Results: The age, weight and gender of the participants was comparable between the groups. Surgery time (25±22mins) did not differ significantly between the groups. There were no significant differences between Rofecoxib and Ibuprofen during all time intervals post-operatively. Ibuprofen was significantly better at reducing pain at all time intervals in comparison to the placebo. Rofecoxib provided significantly better pain relief compared to the placebo, except at 60, 180 and 240 minutes postoperatively. Rescue medication use was significantly lower in the Rofecoxib and Ibuprofen groups in comparison to the placebo group, however there was no significant difference between the Rofecoxib and Ibuprofen groups. Rescue medication was used by 50% of patients receiving Rofecoxib, 25% of patients receiving Ibuprofen, and 94% of patients receiving the placebo. Conclusions: Rofecoxib a more recently developed and more expensive COX-2 inhibitor is as equally effective as Ibuprofen, a commonly used, over the counter analgesic for the relief of acute postoperative pain following third molar surgery.