Impacted Wisdom Teeth Clinical Trial
Official title:
Assessment of Preemptive Analgesic Effect of Caldolor® vs. Ofirmev® on Third Molar Surgery: A Prospective, Randomized, Double-blinded Clinical Trial
This study will compare how effective a single dose of an intravenous (IV) ibuprofen is when
compared to single dose of IV acetaminophen in reducing pain. We will administer this study
medication thirty minutes prior to removal of wisdom teeth. We want to see if administering
these drugs prior to surgery may reduce post-operative pain.
Administration of nonsteroidal anti-inflammatory drug before the onset of inflammation
during surgery will reduce postoperative pain following third molar extraction when compared
to the acetaminophen group. Subjects receiving nonsteroidal anti-inflammatory drug will
consume less opioid medications compared to those receiving preemptive acetaminophen.
The surgical removal of third molars is a common surgical procedure performed in dentistry.
Surgery to extract an impacted third molar can be due to various reasons such as infection,
caries, pain, cyst or tumor formation, or to facilitate orthodontic treatment. Both
clinicians and patients are concerned with the postoperative pain following surgery.
Rationale for model selection The oral surgery model is well-suited for the measurement of
acute pain.The model has been shown to be sensitive to the effects of analgesic drugs and is
useful for examining peripheral biochemical measures of drugs in vivo.This model is
recommended by the US Food and Drug Administration because patients are usually healthy
without complicating medical conditions and most patients have pain for a short, predictable
period after surgery.
Rationale for drug selection Pain from the surgical incision and tissue manipulation
associated with the surgical procedure is instigated immediately. This gives way to
inflammatory pain that follows inflammatory cell recruitment to the injured area within the
course of several hours. Inflammatory pain generally continues for several days, depending
on the nature of the surgical procedure. As a consequence of tissue damage and release of
neurogenic inflammatory mediators, there is activation of specific receptors and pathways
that can contribute to central sensitization and development of hyperalgesia and persistent
pain. While various pharmacological strategies, including the use of opioids, provide
adequate attenuation of pain, their use is associated with undesirable side effects, drug
interactions, pharmacokinetic variability, and often inadequate dosing, all of which can
lead to ineffective analgesia and prolonged suffering. Opioids do not interrupt the
inflammatory component of pain.
The study drug Caldolor® is an intravenous formulation of ibuprofen which was approved by
the FDA in June 2009. Caldolor® is the first injectable product available in the United
States for the treatment of pain and fever. This is the first study in dentistry evaluating
the use of Caldolor® as a preemptive analgesia. Southworth et al and colleagues randomized
406 patients undergoing elective single-site orthopedic or abdominal surgery to 400 mg
intravenous (IV) Caldolor, 800 mg IV Caldolor, or placebo. The results showed that patients
in the 800 mg group had a 25.6% lower median morphine use (P = .026) over the first 24 hours
of treatment than the placebo group. Patients in the 400 mg group did not have a lower use
of morphine, but both the 400 and 800 mg groups reported less pain at rest and with movement
than with placebo.
The comparator group Ofirmev® is intravenous acetaminophen and was recently approved by the
FDA for the management of mild to moderate pain, the management of moderate to severe pain
with adjunctive opioid analgesics, and the reduction of fever. In a study conducted for
total abdominal hysterectomy, preemptive IV paracetamol (acetaminophen) 1 g provided good
quality postoperative analgesia, with decreased consumption of morphine and minimal side
effects. Studies have showed that the use of 1 g of paracetamol as a single intravenous
preemptive dose in abdominal surgery with perioperative epidural analgesia did not reduce
the analgesic consumption and the intensity of pain in the postoperative period.
Use of Pain Scale VAS Pain Scale Score: The primary end point is the clinical report of
pain. Pain intensity will be assessed using a 100 mm VAS with anchors of "no pain" and
"worst pain imaginable" and a 4-point category scale ("none", "mild", "moderate", and
"severe") once pre-operatively and over the post-operative observation period at 30-minute
intervals during the post- surgical time. The category scale is included for purposes of
obtaining a patient-reported assignment of moderate pain (definition of clinically
significant pain), and for computing the cut-offs for pain sensitivity.
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| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Active, not recruiting |
NCT05890040 -
Evaluation of the Effect of Watching Surgery Videos on Social Media on Anxiety Before Impacted Wisdom Tooth Extraction
|