ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Preoperative Administration of Celecoxib (Celebrex) is Effective for Managing Postoperative Pain In Third Molar Extractions
Clinical Question In a healthy adult, is preoperative administration of the nonsteroidal anti-inflammatory drug (NSAID) celecoxib (Celebrex), as compared to a placebo, an effective method for reducing postoperative pain following a third molar extraction?
Clinical Bottom Line For patients requiring third molar extractions, celecoxib (Celebrex) is an effective treatment medication when compared to placebo for managing and reducing of postoperative pain. However, more uniform research methodology is required for the further evaluation of celecoxib and other NSAIDs. This result is supported by a randomized controlled trial and a systematic review that also performed a meta-analysis. Treatment with celecoxib is effective enough to be utilized by the average dental practice and is likely to find compliance with the average patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22421863Al-Sukhun/2012150 adults with an impacted mandibular molarRandomized Controlled Trial
Key resultsIn this study, celecoxib has a positive effect on all pain management parameters set forth by the study: overall effect, time to onset of pain relief (P<0.05), peak pain relief (P<0.05), and duration of effect (P<0.001). Patients that were administered celecoxib experienced greater analgesia and greater overall efficacy than those who received ibuprofen or placebo (P<0.001). The study compared 200 mg celecoxib, 400 mg ibuprofen, or a placebo containing lactose, 1 hour before surgery.
#2) 26061574Costa/2015420 adult patients in 6 included studies (2 studies excluded from meta-analysis, n=298)Meta-Analysis
Key resultsIn this study, various RCTs were evaluated that examined the effectiveness of preoperative NSAIDs on postoperative pain relief for third molar surgery. Inclusion criteria for the study included “NSAIDs administered orally before the mandibular third-molar surgery procedure performed under local anesthesia, without acute symptomatology, with the aim to obtain preemptive analgesia.” (Costa, 2015) The study concluded no preemptive effect was found for NSAIDs (n=298, P=.2227, odds ratio:2.30, 0.60-8.73).
Evidence Search (("preemptively"[All Fields] OR "preemptive"[All Fields]) AND ("analgesias"[All Fields] OR "analgesia"[All Fields]) AND third[All Fields] AND ("molar"[All Fields] OR "molarization"[All Fields] OR "molars"[All Fields])) AND ("2006/03/01"[PDat] : "2016/02/26"[PDat])
Comments on
The Evidence
Validity: 22421863: The RCT had similar groups at the start of the study with a completion rate greater than 80%. The groups were treated the same and had adequate follow-up. The study was double-blind, compliance was adequate, recall bias was unlikely, and no competing interests were identified. 26061574: The meta-analysis was performed for the systematic review of randomized controlled trials. There was a comprehensive and detailed search for relevant trials. Individual studies were assessed for validity utilizing the Cochrane review criteria. 6 trials compose of 420 adult patients were utilized for the systematic review and 4 trials with 298 patients were used for the meta-analysis (2 studies were excluded due to lack of dichotomous data). For the Cochran review criteria, the study Al-Sukhun J/2012 was the strongest of all.
Applicability Applicable to clinicians interested in utilizing preoperative analgesia techniques and methods to reduce postoperative pain in patients requiring 3rd molar extractions. The patient should be an otherwise healthy young adult requiring 3rd molar extractions. Due to the mechanism of action of NSAIDs through inhibition of COX-1 and COX-2, older patients and patients with cardiovascular risks or disease are contraindicated for this intervention. Our PICO question focuses on a patient population, young adults, with low risk for a cardiovascular incident. Patients should also be responsible and capable of following the preoperative drug regimen. The intervention is recommended due to the reduction of postoperative discomfort for the patient and achieving better pain management. Further studies with uniform experimental methodologies must be completed to evaluate the most efficient dosage, dosing regimen, and other surgery factors to optimize the medication’s effects. As mentioned in one study, future experimental models should minimize study differences for “methods of administration, combinations of drugs, evaluation of time of postoperative pain, types of surgery, concomitant use of NSAIDs, use of sedation, and different local anesthetics and vasoconstrictors, which hamper comparison among the effects.” (Costa, 2015)
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Third molar, Extraction, Preoperative analgesia, Preemptive analgesia, Non-steroidal anti-infammatory drugs (NSAIDs), Pain management, Oral surgery, Celecoxib (Celebrex).
ID# 3052
Date of submission: 03/13/2016spacer
E-mail quante@livemail.uthscsa.edu
Author Alexander Quante
Co-author(s) Joel Elizondo
Co-author(s) e-mail joel.elizondo91@gmail.com
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail spackman@uthscsa.edu
Basic Science Rationale
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