A COMPARATIVE EFFICACY OF IBUPROFEN, CELECOXIB AND TRAMADOL ON POSTOPERATIVE PAIN CONTROL FOLLOWING IMPACTED MANDIBULAR THIRD MOLAR EXTRACTION: A RANDOMIZED CONTROLLED TRIAL. By Akinbade A.O, Ugboko V.I, Owotade FJ, Ndukwe K.C. Department of Oral and Maxillofacial Surgery,
A COMPARATIVE EFFICACY OF IBUPROFEN, CELECOXIB AND TRAMADOL ON POSTOPERATIVE PAIN CONTROL FOLLOWING IMPACTED MANDIBULAR THIRD MOLAR EXTRACTION: A RANDOMIZED CONTROLLED TRIAL.
Akinbade A.O, Ugboko V.I, Owotade FJ,
Department of Oral and Maxillofacial Surgery,
Obafemi Awolowo University Teaching Hospitals Complex,
Postoperative pain results from the release of large series of pain mediators activated by inflammatory process caused by surgical trauma.
Studies had shown that management of postoperative pain is still a great challenge and far from being satisfactory.
A plethora of analgesics are available for postoperative pain control after 3rd molar surgery : Antipyretic analgesic, Non- steroidal Anti-inflammatory Drugs(NSAIDs) and Opioids.
Cyclooxygenase 1 & 2 can initiate the metabolism of arachidonic acid to prostaglandins.
All t-NSAIDs inhibits both COX 1 & 2 and are associated with an increased gastrointestinal complications.
Tramadol is a centrally acting analgesic structurally similar to codeine and morphine.
Evidence-based study on efficacy of Ibuprofen, Celecoxib and Tramadol is lacking.
extraction, confirmed by periapical radiographs.
1. Participants with acute infection involving the mandibular third molar in question.
2. Participants with uncontrolled medical or systemic disease contraindicating surgical extraction under local anesthesia e.g. compromised cardiac function, hematological abnormalities, metabolic disorders, central nervous system disorder, impaired renal or hepatic function or depressed respiratory functions.
3. History of allergy or hypersensitivity to Ibuprofen, Celecoxib and Tramadol.
4. Participants with peptic ulcer disease, pregnancy or breastfeeding.
5. Participants with history of psychological or physical dependence on opioids.
6. History of use of analgesic in the previous 24 hours.
7. Unwillingness of patient to give informed consent.
There were 45 of such envelopes for each of the 3 study groups. There was no inscription of name or symbol on the tablets and capsules or anything that could reveal the identity of any the drugs. This assisted in ensuring the blinding of the participants to the drugs.
Each medication was labeled with a medication code number according to the randomization sequence that has been generated by an independent observer before the commencement of the study.
They were then properly educated on how to record their pain intensity on the visual analogue scale by placing a vertical mark with a pen across the horizontal line of the VAS at the point they felt represented the pain they felt at intervals.
Participants were then asked to record the pain intensity felt before the extraction, immediately after extraction thereafter, serially at 4 hours, 8 hours, 16 hours, 24 hours and 48hours after the extraction using the visual analogue scale.
Participants were also asked to record any side effect or complication of the medication they felt.
The VAS scores were determined by measuring in millimeters from the left end of the VAS to the point that participant marks.
Statistical analysis was done using intention- to- treat analysis.
These participants were randomized into three groups of 45 each based on the medication they received.
Group B. Participants in this group received Ibuprofen. Four patients failed to return the VAS form.
Group C. Participants in this group received Celecoxib. Only one of them discontinue the medication at 24 hours after the extraction.
VARIABLE Tramadol Ibuprofen Celecoxib
Mean age(years 25.75±5.36 27.22±7.13 26.56±6.29
Gender [(freq (%)]
Male 15(33.33) 17(37.78) 16(35.56)
Female30(66.67) 32(71.11) 29(64.44)
Primary 1(2.22) 0(0) 1(2.22)
Secondary 3(6.67) 6(13.33) 2(4.44)
Tertiary 41(91.11) 39(86.67) 41(91.11)
No education 0(0) 0(0) 1(2.22)
There is paucity of information on comparative efficacy of Ibuprofen, tramadol & Celecoxib.
They found out that pain severity was lower in ibuprofen than celecoxib and tramadol groups at 4 and 8 hours after extraction.
The finding of this study that Celecoxib was more efficacious than Ibuprofen and tramadol differs from that of Zamiri et al but agree with Tramadol as the least efficacious of the 3 drugs.
Cheung and associates in a single dose randomized, double blind, active- and placebo-controlled study found out that mean time to onset of analgesia with celecoxib 400mg and Ibuprofen 400mg are comparable.
Loading dose of celecoxib 400mg achieves the plasma concentration needed for early analgesic efficacy and which is maintained by subsequent 12 hourly administration of 200mg.
Tramadol was the least efficacious in this study in agreement with Zamiri et al.
The multiple doses administered in the present study compared with previous ones allowed:
1. Assessment of the effectiveness of the drugs over a long period of time.
2. Assessment of adverse effects and tolerability of the drugs.
Celecoxib and ibuprofen appeared to be generally tolerable whereas tramadol was significantly associated with adverse effects.
Ong KS, Seymour RA. Pathogenesis of Post-operative oral surgical pain. Anesth Prog 2003;50:5-17.
Cheung R, Kowalski K. Analgesic efficacy of celecoxib in postoperative oral surgery pain: A single-dose, two centre, randomized, double blind, active and placebo-controlled study. ClinTher 2007;29:44.