Pre-emptive efficacy of sustained-release ibuprofen and etoricoxib in third molar surgery

Abstract

Objective

To compare the effect of pre-emptive administration of sustained-release (SR) ibuprofen 1.6g and etoricoxib 120mg on pain, swelling, trismus, and the quality of life following impacted third molar surgery.

Methods

In this single-centre, double-blinded randomised control trial, participants were randomly assigned to receive oral SR ibuprofen 1.6g or etoricoxib 120mg 2 hours before third molar surgery. In the first 48-hour postoperative period, participants rated their pain intensity every 3 hours, while awake, and recorded their use of rescue analgesia. A preoperative and 48-hour time point measurements were taken for facial swelling, trismus, and the quality of life. The postoperative facial swelling was determined by the volumetric differences between the pre- and postoperative 3D photographs of the participants, using the 3dMDtrio system (3dMD, Atlanta, GA). Trismus was assessed indirectly, by measuring the pre- and postoperative interincisal distances at the maximum mouth opening. The quality of life was assessed using the short-form Oral Health Impact Profile (OHIP-14). Categorical data of the two study groups were compared using Chi-square tests. Clinical characteristics were compared and tested for statistical significance using Analysis of variance. A P value of less than 0.05 (P<0.05) was considered statistically significant.

Results

Study sample included 135 participants: SR ibuprofen (n=68) and etoricoxib (n=67). Despite observing an overall slightly higher pain level in the SR ibuprofen group than the etoricoxib group throughout the study period, the difference was not statistically significant. Just over 50% of participants in both groups required rescue analgesia (p=0.78), while the mean time to first rescue analgesia was 5 hours postoperatively (p=0.66). The total number of rescue analgesics consumed was comparable between the two groups (p=0.14). There were no significant differences between the two groups in facial swelling (p=0.80), trismus (p=0.86), and the mean OHIP-14 score (p=0.26).

Conclusion

With no significant differences observed between the performance of the two drugs in acute postoperative sequelae, pre-emptive administration of the more economical SR ibuprofen could be used as a suitable alternative to etoricoxib in third molar surgery.