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A randomized double blind controlled trial comparing Ibuprofen versus Ibuprofen plus Acetaminophen plus Caffeine for pain control after impacted third molar surgery

DOI: 10.4236/ojst.2012.22020, PP. 110-115

Keywords: Third Molar Surgery, Pain Control, Ibuprofen, Acetaminophen, Caffeine

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Abstract:

Non-steroidal anti-inflammatory drugs like Ibupro- fen alleviate mild to moderate postoperative pain caused by the third molar extractions. Moreover, Acetaminophen is a non-opioid analgesic with anti-pyretic properties, effective in relieving mild to moderate pain. On the other hand, recent studies have demonstrated that Caffeine also acts as an analgesic adjuvant when combined with Acetaminophen, Aspirin, or their mixture. The objective of study is to compare the efficacy of a combination of Ibuprofen 200 mg and Acetaminophen 325 mg plus Caffeine 40 mg with Ibuprofen 400 mg alone for relieving the pain after surgical removal of impacted mandibular third molar. 80 adult patients (56 females, 24 males) were randomly placed into two groups. Preoperative pain recorded prior to the surgery and compare with patients’ pain after the operation. According to findings, there was no significant relationship between preoperative and postoperative pain (P value > 0.05) and also between surgical trauma and postoperative pain (P value > 0.05). The mean pain showed a slight numerical superiority for the group which used Ibu-profen plus Acetaminophen plus Caffeine especially 3hours after surgery, but there was no significant difference between the two groups (P value = 0.073). In conclusion, combination of Ibuprofen plus aceta-minophen plus caffeine does not offer any clinical advantages compared with Ibuprofen for alleviating acute postoperative pain after third molar surgeries.

References

[1]  Babatunde, O.B., Jelili, A.A., Wasiu, L.A., Akinola, L.L., Godwin, T.A. and Mobolanle, O.O. (2005) Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head & Face Medicine, 7, 1-11. doi:10.1186/1746-160X-1-11
[2]  Conrad, S.M., Blakey, G.H., Shugars, D.A., et al. (1999) Patient’s perception of recovery after third molar surgery. Journal of Oral and Maxillofacial Surgery, 57, 1288- 1294. doi:10.1016/S0278-2391(99)90861-3
[3]  Tiwana, P.S., Foy, S.P., Shugars, D.A., Marciani, R.D., Conrad, S.M., Phillips, C., White, R.P. (2005) The impact of intravenous corticosteroid with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery. Journal of Oral and Maxillofa- cial Surgery, 63, 55-62. doi:10.1016/j.joms.2004.01.029
[4]  Zuniga, J.R., Phillips, C.L., Shugars, D., Lyon, J.A., Peroutka, S.J., Swarbrick, J., Bon, C. (2004) Analgesic safety and efficacy of diclofenac sodium softgels on postoperative third molar extraction pain. Journal of Oral and Maxillofacial Surgery, 62, 806-815. doi:10.1016/j.joms.2003.12.019
[5]  Cooper, S.A. and Beaver, W.T. (1976) A model to eva- luate mild analgesics in oral surgery outpatients. Clinical Pharmacology & Therapeutics, 20, 241-250.
[6]  Seymour, R.A., Ward-Booth, P. and Kelly, P.J. (1996) Evaluation of different doses of soluble ibuprofen and ibuprofen tablets in postoperative dental pain. British Journal of Oral and Maxillofacial Surgery, 34, 110-114. doi:10.1016/S0266-4356(96)90147-3
[7]  Moore, A., Collins, S., Carroll, D., McQuay, H. and Ed- wards, J. (2000) Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. Cochrane Database of Systematic Reviews, 2, CD001547.
[8]  Rang, H.P., Dale, M.M. and Ritter, J.M. (1999) Anti- inflammatory and immunosuppresant drugs. Pharmacol- ogy, 4th Edition, Churchill Livingstone, Edinburgh, 229- 247.
[9]  Merry, A.F., Gibbs, R.D., Edwards, J., Ting, G.S., Fra- mpton, C., Davies, E. and Anderson, B.J. (2010) Com- bined acetaminophen and ibuprofen for pain relief after oral surgery in adults: A randomized controlled trial. British Journal of Anaesthesia, 104, 80-88. doi:10.1093/bja/aep338
[10]  Diamond, S. and Freitag, F.G. (2001) The use of ibu- profen plus caffeine to treat tension-type headache. Current Pain and Headache Reports, 5, 472-478.
[11]  Forbes, J.A., Beaver, W.T., Jones, K.F., Kehm, C.J., Smith, W.K., Gongloff, C.M., Zeleznock, J.R. and Smith, J.W. (1991) Effect of caffeine on ibuprofen analgesia in postoperative oral surgery pain. Clinical Pharmacology & Therapeutics, 49, 674-684. doi:10.1038/clpt.1991.85
[12]  Desmeules, J., Rollason, V., Piguet, V. and Dayer, P. (2003) Clinical pharmacology and rationale of analgesic combinations. European Journal of Anaesthesiology, 20, 7-11.
[13]  Seymour, R.A. and Walton, J.G. (1984) Pain control after third molar surgery. International Journal of Oral Sur- gery, 13, 457-485. doi:10.1016/S0300-9785(84)80017-4
[14]  Fisher, S.E., Frame, J.W., Rout, P.G.J. and McEntegart, D.J. (1988) Factors affecting the onset and severity of pain following the surgical removal of unilateral im- pacted third molar teeth. British Dental Journal, 164, 351-354. doi:10.1038/sj.bdj.4806453
[15]  Bj?rnsson, G.A., Haanaes, H.R. and Skoglund, L.A. (2003) A randomized, double-blind crossover trial of paracetamol 1000 mg four times daily vs ibuprofen 600 mg: effect on swelling and other postoperative events af- ter third molar surgery. British Journal of Clinical Phar- macology, 55, 405-412. doi:10.1046/j.1365-2125.2003.01779.x
[16]  Dionne, R.A. and Cooper, S.A. (1978) Evaluation of pre- operative ibuprofen for post-operative pain after removal of 8/8. Journal of Oral Surgery, 45, 851-856.
[17]  Geisslinger, G., Dietzel, K., Bezler, H., Nuernberg, B., Brune, K. (1989) Therapeutically relevant differences in the pharma-cokinetical and pharmaceutical behavior of ibuprofen lysinate as compared to ibuprofen acid. Inter- national Journal of Clinical Pharmacology, Therapy and Toxicology, 27, 324-328.
[18]  Bergner, T. and Przybilla, B. (1992) Photosensitization caused by ibuprofen. Journal of the American Academy of Dermatology, 26, 114-116. doi:10.1016/0190-9622(92)70018-B
[19]  Knochen, M., Giglio, J. and Reis, B.F. (2003) Flow-in- jection spectrophotometric determination of paracetamol in tablets and oral solutions. Journal of Pharmaceutical and Biomedical Analysis, 33, 191-197. doi:10.1016/S0731-7085(03)00342-X
[20]  Rodenas, V., Garc??a, M.S., Sánchez-Pedre?o, C. and Albero, M.I. (2000) Simultaneous determination of pro- pacetamol and paracetamol by derivative spectrophotometry. Talanta, 52, 517-523. doi:10.1016/S0039-9140(00)00397-0
[21]  Garcia Rodríguez, L.A. and Hernández-Díaz, S. (2001) The risk of upper gastrointestinal complications associ- ated with nonsteroidal anti-inflammatory drugs, gluco- corticoids, acetaminophen, and combinations of these agents. Arthritis Research, 3, 98-101. doi:10.1186/ar146
[22]  Walter, R.B., Milano, F., Brasky, T.M. and White, E. (2011) Long-term use of acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs and risk of hematologic malignancies: results from the prospective Vitamins and Lifestyle (VITAL) study. Journal of Cli- nical Oncology, 29, 2424-2431. doi:10.1200/JCO.2011.34.6346
[23]  Zen, J.M., Ting, Y.S. and Shih, Y. (1998) Voltammetric determination of caffeine in beverages using a chemically modified electrode. Analyst, 123, 1145-1147. doi:10.1039/a708360b
[24]  Fisone, G., Borgkvist, A. and Usiello, A. (2004) Caffeine as a psychomotor stimulant: Mechanism of action. Cellu- lar and Molecular Life Sciences, 61, 857-872. doi:10.1007/s00018-003-3269-3
[25]  Cooper, S.A., Precheur, H., Rauch, D., Rosenheck, A., Ladov, M. and Engel, J. (1980) Evaluation of oxycodone and acetaminophen in treatment of postoperative dental pain. Oral Surgery, Oral Medicine, Oral Pathology, 50, 496-501. doi:10.1016/0030-4220(80)90430-2
[26]  Din?, E. (1999) A comparative study of the ratio spectra derivative spectrophotometry, Vierordt’s method and high-performance liquid chromatography applied to the simultaneous analysis of caffeine and paracetamol in tab- lets. Journal of Pharmaceutical and Biomedical Analysis, 21, 723-730. doi:10.1016/S0731-7085(99)00186-7
[27]  Safavi, A. and Tohidi, M. (2007) Simultaneous kinetic determination of levodopa and carbidopa by H-point standard addition method. Journal of Pharmaceutical and Biomedical Analysis, 44, 313-318. doi:10.1016/j.jpba.2007.02.020
[28]  Mitchell, A., Van Zanten, S.V., Inglis, K. and Porter, G. (2008) A randomized controlled trial comparing aceta- minophen plus ibuprofen versus acetaminophen plus co- deine plus caffeine after outpatient general surgery. Journal of the American College of Surgeons, 206, 472- 479. doi:10.1016/j.jamcollsurg.2007.09.006

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