Clinical article
Effect of pretreatment with acetaminophen-propoxyphene for oral surgery pain

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Abstract

To determine the effect of pretreatment and multiple doses on postsurgical pain, a study of the relative analgesic efficacy of placebo, acetaminophen 650 mg, and propoxyphene napsylate 100 mg alone and in combination was conducted. Forty-five patients undergoing surgical removal of impacted third molar teeth under local anesthesia were randomly allocated to the four treatment regimens under double-blind conditions. The first oral dose was administered one hour preoperatively and the second dose when the pain became moderate or severe, following the dissipation of the local anesthesia. Pain intensity and pain relief were assessed using standard verbal descriptor scales at 30 mintues and hourly for four hours after the postoperative dose. Measures of total effect, peak effect and duration of their effect were derived from these descriptors. Acetaminophen was no better than placebo. For peak and total effects, propoxyphene alone and the propoxyphene-acetaminophen combination were substantially superior to both placebo and acetaminophen alone. Duration of analgesia was also significantly longer with both propoxyphene-containing treatments. No side effects were reported. The results suggest that pretreatment with a narcotic agonist markedly improves postoperative analgesia.

References (13)

  • RA Dionne et al.

    Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars

    J Oral Surg

    (1978)
  • R.W. Houde et al.

    Clinical pharmacology of analgesics. A method of assaying analgesic effect

    Clin Pharmacol Ther

    (1960)
  • H.K. Beecher et al.

    The effectiveness of oral analgesics (morphine, codeine, and acetylsalicylic acid) and the problem of placebo “reactors” and “non-reactors”

    J Pharmacol Exp Ther

    (1953)
  • S.A. Cooper et al.

    A model to evaluate mild analgesics in oral surgery outpatients

    Clin Pharmacol Ther

    (1976)
  • P.J. Desjardins et al.

    The relative analgesic efficacy of propiram fumarate, codeine, aspirin, and placebo in post-impaction dental pain

    J Clin Pharmacol

    (1984)
  • S.S. Bloomfield et al.

    Aspirin and codeine in two post-partum models

    Clin Pharmacol Ther

    (1976)
There are more references available in the full text version of this article.

Cited by (8)

  • Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials

    2020, Journal of Cranio-Maxillofacial Surgery
    Citation Excerpt :

    As for trismus, the studies showed a worse scenario between 48 h and 72 h, with mouth opening reestablished after 7 days (Avelar et al., 2012; Akbulut et al., 2014; Costa et al., 2015; Albuquerque et al., 2017; Cigerim and Eroglu, 2018). The protocol of preemptive analgesia varied across studies, with timing before surgery ranging widely: 15 min before surgery (Borea et al., 1996), 20 min (Hyrkas, 1994), 30 min (Dionne and Cooper, 1978; Dionne et al., 1983; Hill et al., 1987; Dupuis et al., 1988; Sisk and Grover, 1990; Chiu and Cheung, 2005; Neychev et al., 2017), 60 min (Liashek et al., 1987; Jung et al., 2005; Morse et al., 2006; Lau et al., 2009; Kaczmarzyk et al., 2010; Bretas et al., 2011; Al-Sukhun et al., 2012; Avelar et al., 2012; Da Costa Araujo et al., 2012; Shah et al., 2012; Simone et al., 2013; Akbulut et al., 2014; Costa et al., 2015; Kaplan and Eroglu, 2016; Solís et al., 2016; Albuquerque et al., 2017; Cigerim and Eroglu, 2018), 90 min (Aoki et al., 2006; Lisboa and Pilatt, 2013), 120 min (Asadi et al., 2017), 12 h before (Pektas et al., 2007), 48 h before (Liporaci Junior, 2012), or not reported (Cheung and Rodrigo, 1992; Lustenberger et al., 2011). The most frequently used rescue medication was paracetamol (20 studies).

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Performed under the United States Navy Clinical Investigation program, Study #84-16-1994. The voluntary informed consent of the subjects used in this research was obtained as required by the Secretary of Navy Instruction 3900.39.

The opinions or assertions expressed in this paper are those of the authors and are not to be construed as official or as necessarily reflecting the views of the Department of the Navy or the Naval Service.

Lieutenant Commander, Dental Corps, United States Navy, Naval Medical Research Institute, Bethesda, Maryland.

Associate Professor, Departments of Biodental Sciences and Oral and Maxillofacial Surgery, CMDNJ-New Jersey Dental School, Newark, New Jersey.

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