Per Løkken

Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid

SummaryIn a controlled crossover study, “identical” surgical procedures, the prophylactic removal of bilateral non-erupted 3rd molar teeth, were performed on two separate occasions in 24 healthy patients. Prior to each procedure, either betamethasone 9 mg (Celeston Chronodose®) or placebo was administered intramuscularly, in a randomized fashion. Objective and subjective assessments were recorded for paired comparison of the post-operative course, including swelling, pain, trismus, local temperature, bleeding, wound-healing and preference for treatment. In 23 patients, less swelling occurred when betamethasone was given pre-operatively. The mean reduction on the 3rd and 6th post-operative days was 55% (p<0.001) and 69% (p<0.001), respectively. Pain assessments (visual analogue scale) were significantly lower after the corticosteroid injection; mean response: 1st evening 17 vs 56 mm, 2nd evening 5 vs 37 mm, and 3rd evening 2 vs 13 mm. No significant correlation between the steroid-induced reduction in swelling and pain could be made. This may indicate that dissociation may exist between pain and other inflammatory events like swelling. No clinically apparent infection or other disturbance of wound-healing was noted after corticosteroid administration. This treatment course was preferred by 23 of the 24 patients.

Paracetamol versus placebo: Effects on post-operative course

SummaryParacetamol was compared with placebo in a double-blind crossover study, in which essentially the same operation was performed on two separate occasions in 24 healthy patients, namely surgical removal of bilateral impacted wisdom teeth. Commencing on the day of surgery, either paracetamol (Panodil®; 1.0 g×4 for 2 days, then 0.5 g×4 for the next 2 days) or placebo tablets were given, followed by crossover to the alternative treatment at the second operation about 4 weeks later. Several objective and subjective assessments were recorded for paired comparison of post-operative courses. Swelling on the 3rd day after operation when paracetamol was given averaged 71% of that measured when placebo was given (p<0.05). After paracetamol, a tendency was noted towards reduced local hyperpyrexia and less post-operative bleeding. The pain and preference scores were clearly in favour of paracetamol. The results provide evidence to suggest that paracetamol may reduce an acute, posttraumatic inflammatory reaction.

Acetylsalicylic acid vs paracetamol: Effects on post-operative course

SummaryAcetylsalicylic acid(ASA) was compared with paracetamol(P) in a double-blind crossover study, in which essentially the same operation was performed on two separate occasions in 32 healthy patients, who required surgical removal of bilateral “identically” impacted wisdom teeth. Sixteen patients were given the drugsboth before andafter(b & a-group) the operations (0.5 g on the pre-operative evening, followed by 0.5 g × 4 for 3 days); the other 16 patients did not start treatment until 2 hoursafter(a-group) the operations. A number of objective and subjective factors were assessed, including swelling, bleeding, pain and preference, and were used to make comparisons of the pre-, per-and post-operative courses. About 50% greater post-operative swelling was associated withASA compared toP, either if medication was begun prior to surgery or if the drugs were given only after operation. In theb & a-group, interference with platelet function and prolonged pre-operative bleeding time were produced byASA (8.9 vs 6.5 min), but the per-operative blood loss was not significantly increased (7.8 vs 7.4 ml). In both groupsASA tended to increase post-operative bleeding and the formation of haematomas and ecchymoses. There was no noticeable difference betweenASA andP with respect to pain score, but the preference scores showed a tendency to favourP in both groups. It appears that in circumstances with acute tissue injuries,P should be preferred toASA, if post-traumatic swelling and bleeding are to be prevented or reduced.

Reduction of pain and swelling by a corticosteroid injected 3 hours after surgery

SummaryA main reason for investigating the clinical effects and possible merits of post-operative corticosteroid administration was its practical implications in traumatology. It was also hoped to obtain information relevant to the analgesic activity of steroid. A crossover study has been done in 12 healthy subjects, each of whom had two separate, but identical operations for removal of non-erupted 3rd molar teeth on each side of the jaw. 3 h after surgery, either betamethasone 9 mg (Celeston Chronodose®) or placebo was injected intramuscularly in a randomized fashion. A paired comparison was made of the post-operative courses. All but 1 patient experienced less pain after the steroid injection. Surprisingly, some patients reported pronounced relief within min after the injection, whereas in others there was a time-lag. Swelling, measured on the 3rd day, was reduced by 47% after the steroid as compared to placebo. There was poor agreement between the steroid-induced reductions in pain and swelling. This exemplifies the dissociation between pain and other inflammatory events, and indicates that the analgesic and anti-inflammatory properties of a steroid may depend on discrete mechanisms, which may show considerable individual variation. From overall assessment, all 12 patients favoured the post-operative course when the steroid was administered. Almost the same levels of pain relief, reduction in swelling, and preference were reached in the present patients, who received the steroid 3 h post-operatively, as had previously been found in a similar trial in which the drug was injected prior to surgery. The results suggest that short term corticosteroid administration may be a valuable means of reducing pain and excessive inflammatory response after surgical or accidental soft tissue/bone injury.

Effect of acetylsalicylic acid, paracetamol, and placebo on pain and blood loss in dysmenorrhoeic women

SummaryThe analgesic effect of paracetamol, acetylsalicylic acid, and placebo on dysmenorrhoea were compared in a double-blind crossover study of 30 women. There was a moderate placebo effect, but no significant difference was found between the three treatments. Blood loss was also measured and it did not vary with the type of drug ingested. It is concluded that paracetamol and acetylsalicylic acid in the doses used (0.5 g×4 for 3 days) were not effective against heavy dysmenorrhoea, and that none of the drugs influenced the amount of blood lost.

Phenazone versus placebo: Effects on post-operative course

SummaryIn a double-blind crossover study essentially the same operation was performed twice in 24 patients who required surgical removal of bilateral “identically” impacted wisdom teeth. On one occasion they were given phenazone (1.0 g×4 for 2 days, then 0.5 g×4 for the next 2 days), on the other placebo tablets. Several objective and subjective assessments were recorded to permit paired comparison of the post-operative courses. Swelling on the 3rd day after the operation when phenazone was given averaged 82% of that when placebo was used (p>0.10). The local temperature increase was somewhat reduced with phenazone (0.72 vs 1.10 °C) and there was a smaller reduction in mouth-opening ability (29 vs 41%), but there was a tendency towards a slightly greater post-operative bleeding score with the drug. Significant pain relief was obtained with phenazone according to assessment both by fixed interval scores and a visual analogue scale. Although nausea was experienced by some of the patients when given phenazone (possibly related to the rather high dose), the preference scores were clearly in favour of the drug. Compared to results previously obtained in this model, phenazone may be preferable to acetylsalicylic acid in oral surgery, but phenazone does not compare favourably with the results obtained with paracetamol.

[Mouth-rinsing with chlorhexidine for prevention of pneumonia].

Oral decontamination with chlorhexidine prevents accumulation of pathogens in the oral cavity, and can thereby reduce the risk of translocation to and colonization of the lungs. The antiseptic agent chlorhexidine has been widely used in dentistry, it has an excellent record of safety and efficacy and a broad antimicrobial spectrum. Mouth-rinsing with chlorhexidine may result in 90 % reduction of oral microbes. Cooperation between physicians and dentists is important in this area on the borderline between the two professions.

The rise and fall of a new anti-inflammatory analgesic

The efficacy of a new non-steroidal anti-inflammatory drug (NSAID), GP 53.633 (GP), was tested versus placebo in a double-blind cross-over study. 24 healthy young individuals with impacted asymptomatic lower third molars, of similar shape and position in the jaw on both sides, underwent surgery on 2 separate occasions. The patients randomly received the active drug at one and placebo at the other operation. A number of subjective and objective assessments were made for paired comparison, including: pain, local temperature, swelling, post-operative bleeding, trismus, adverse effects, preference scores, wound healing, bone regeneration and laboratory examinations. The drug caused a significant reduction of post-operative pain, swelling and trismus. Global therapeutic effect and preference scores were highly in favour of the active drug. In the GP period, there was a statistically significant reduction in Hgb, RBC, lymphocytes and ESR, and an increase in neutrophils 3 days after the operation, compared to placebo. Individual values indicate a potentially clinically relevant effect of GP on Hgb and RBC. The clinical relevance of the changes in neutrophil and lymphocyte count, however, is questionable. The drug seemed to have no influence on the other laboratory parameters studied. Adverse effects occurred in 2 patients on GP and in 7 patients on placebo. The drug compares favourably with other NSAID tested in the same model.