Patients in the fast dissolving paracetamol mg group reported less postoperative pain and increased time to first rescue analgesics than patients in either the normal dose of paracetamol mg or fast dissolving paracetamol mg tablets groups. The current study result is similar to the findings from the study by Derry et al, 24 who reported that the clinical advantages for using fast-dissolving and absorbed diclofenac potassium is including better pain relief than those that are absorbed slowly.
They concluded that diclofenac potassium at 50 mg single dose is considered as a good pain relief for moderate postoperative pain in adults. A Cochrane overview was conducted by Moore et al 25 to summarize the efficacy of a single dose of oral analgesics for postoperative acute pain relief in adults. Thirty-nine Cochrane reviews of randomized trials have examined the analgesic efficacy of individual drug interventions in acute postoperative pain. The results of this Cochrane study confirmed that the use of single dose of analgesics is sufficient to achieve good and long lasting pain relief at relatively low doses.
This can be achieved by using fast acting formulations and fixed dose combinations of analgesics. The second possible account for the superiority of diclofenac potassium over ibuprofen and paracetamol could be as a result of the slight differences in their mechanism of actions.
Both diclofenac potassium and ibuprofen have similarity in the mode of action because they exert their efficacy by blocking the effect of COX enzymes. Less prostaglandins are produced. Peripherally, both diclofenac potassium and ibuprofen Inhibit the construction of the prostaglandin particularly PGE2 at peripheral pain receptor. The result of this study reported that the patients in the etodolac group recorded lower intensity of postoperative pain, swelling, and trismus than those having oral dose of ibuprofen.
Diclofenac potassium 50 mg tablets used in this study was faster in dissolving and absorbing than ibuprofen mg tablets. So, a rapid onset and longer duration of action was achieved by using diclofenac potassium. Patients in diclofenac potassium group had less pain at 4 hours and 6 hours postoperatively, and required less rescue analgesic than patients in the paracetamol group.
Differences between diclofenac potassium and paracetamol in reducing postoperative pain intensity due to their mode of actions. There is considerable evidence that the antipyretic effect of paracetamol is centrally by inhibiting of prostaglandin E synthesis within the hypothalamus. El Batawi 36 administered one hour preoperatively a paracetamol and diclofenac sodium for children with traumatic dental treatments under general anesthesia.
Another study carried out by Eslampour et al, 37 who compared the effectiveness of 3 analgesic drugs, which were administrated preoperatively for reducing postoperative pain associated with photorefractive keratectomy. Their findings revealed that the patients in diclofenac group reported less pain than patients in paracetamol and ibuprofen groups. These results also exposed that patients who showed greater levels of distress preoperatively, showed significantly lower levels of distress after the dental extraction and deep cavity preparations.
There was a very interesting point to show in this study, that distress scores were influenced by the lower levels of pain intensity which the patients recorded at the postoperative stage of the assessment. This study has highlighted a new area for further research. These include investigating if there are analgesics effects of paracetamol, ibuprofen, and diclofenac on the level of cortisone and adrenaline in the patients who showed high and lower scores of pain and distress.
Do analgesics exert effect on the level of cortisone and adrenaline in the blood? In conclusion, this study has shown that diclofenac potassium was more effective than paracetamol or ibuprofen for postoperative analgesia in adults who are having teeth extracted and deep cavities prepared under local anesthesia. Preemptive analgesics play an important role in reducing postoperative pain and distress associated with painful dental procedures under LA.
Using diclofenac potassium could be of great help to patients who are in moderate to severe pain. So it is strongly recommended for all dental surgeons and practitioners in the Saudi Arabia to administer diclofenac potassium preoperatively for their patients with traumatic dental treatments.
In this study, there were no female patients participation because in Taibah University College of Dentistry, only male patients are treated. Therefore, the sample size with male and female patients might have more valid conclusion. We would like to thank the dentists, dental assistants, receptionists, and the Oral and Maxillofacial and Restorative Units staff involved in the local anesthetic extraction and cavities preparation services in Taibah College of Dentistry, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia.
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National Center for Biotechnology Information , U. Journal List Saudi Med J v. Saudi Med J. Al-Samadani , PhD. Khalid H. Author information Article notes Copyright and License information Disclaimer. Address correspondence and reprint request to: Dr. E-mail: ku. Received Aug 3; Accepted Dec 7. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Abstract Objectives: To compare the effectiveness of different oral analgesics for relieving pain and distress in adults following the extraction of teeth and deep cavity preparations under local anesthesia. Methods: This randomized controlled study was conducted between November and May Conclusions: Diclofenac potassium was more effective than paracetamol or ibuprofen for reducing postoperative pain associated with tooth extraction and deep cavity preparation.
Methods This randomized controlled study was conducted between November and May Open in a separate window. Figure 1. Figure 2. Statistical analysis Sample size calculation of this study was based on the study by Gazal et al.
Results Of the recruited, 10 patients were excluded by the dental surgeon as they were considered unsuitable for including in this study 5 had LA overdoses, 2 fainted after local anesthetic injection, 2 of their teeth extraction was carried out surgically and one refused extraction after local anesthetic injection. Table 1 Comparison between mean pain scores for the paracetamol, ibuprofen, and diclofenac potassium groups 2, 4 and 6 hours post operatively.
Table 2 A summary of the number of patients who requested rescue analgesics in paracetamol, ibuprofen, and diclofenac potassium groups postoperatively. Table 3 Comparisons between mean distress scores for the patients in the preoperative and postoperative groups.
Discussion Clinically, the findings of this study revealed that all the 3 preemptive analgesics paracetamol at dosage of 1 g, ibuprofen at dosage of mg and diclofenac potassium at dosage of 50 mg reduced the post extraction and deep cavity preparation pain intensity and the need for rescue analgesic.
Acknowledgment We would like to thank the dentists, dental assistants, receptionists, and the Oral and Maxillofacial and Restorative Units staff involved in the local anesthetic extraction and cavities preparation services in Taibah College of Dentistry, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. Footnotes Disclosure. Illustrations, Figures, Photographs. References 1. Three-dimensional evaluation of postoperative swelling after third molar surgery using 2 different cooling therapy methods: a randomized observer-blind prospective study.
J Oral Maxillofac Surg. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. Analgesic efficacy with rapidly absorbed ibuprofen sodium dihydrate in postsurgical dental pain: results from the randomized QUIKK trial. Int J Clin Pharmacol Ther. I'm worried about falling asleep. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.
Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. Make sure you take your medication as directed on the label of the pack. In this article About diclofenac Before taking diclofenac How to take diclofenac Getting the most from your treatment Diclofenac side-effects How to store diclofenac Important information about all medicines.
Common diclofenac side-effects What can I do if I experience this? Indigestion or heartburn acid reflux , stomach pain Try taking your dose after a meal if you are not already doing so. If the discomfort continues, speak with your doctor Feeling sick nausea Stick to simple meals - avoid rich or spicy foods Diarrhoea Drink plenty of water to replace the lost fluids.
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Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Start symptom checker. Tablets, gastro-resistant tablets, prolonged-release tablets and capsules, suppositories, mouthwash. Diclofenac potassium is immediate release, while Diclofenac sodium is delayed release. This implies that for acute and severe pain, it is better to take Diclofenac potassium than Diclofenac sodium. One tendency that has been noted is for doctors to simply write Diclofenac when they mean Diclofenac sodium, whereas they clearly write full name of Diclofenac potassium.
In China, it is sold as Diclofenac sodium, while in some countries, only potassium salt is available. Injections of Diclofenac are also very common when the pain is acute and the patient cannot wait for the drug to show effect if taken orally.
My pharmacy charges way more for the potassium than the sodium. Wonder why?
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