A clinical evaluation of the analgesic efficacy of preoperative administration of ketorolac and dexamethasone following surgical removal of third molars.

The purpose of this study was to compare the postoperative analgesic efficacy of the presurgical intravenous administration of a steroid (dexamethasone), a nonsteroidal anti-inflammatory drug (ketorolac), and a combination of the two medications. These drugs were administrated preoperatively, and their analgesic effects were assessed following the removal of four third molars using intravenous sedation (Fentany/Midazolam) and local anesthetic (2% lidocaine with 1:100,000 epinephrine). Thirty-four patients were randomly assigned to one of four groups: Group I (control), saline; Group II, 30 mg ketorolac; Group III, 8 mg dexamethasone; and Group IV, 30 mg ketorolac + 8 mg dexamethasone. Pain was assessed with the Heft-Parker graphic pain rating scale; the initial survey was completed preoperatively. The teeth were surgically removed by one of four oral and maxillofacial surgeons. Following surgery and initial recovery, the patients completed the second survey and were then admitted for overnight observation. The patients completed the remaining pain rating scales at 2-hr intervals for 12 hr. The last survey was completed at discharge (24 hr postoperatively). A postoperative narcotic analgesic was provided upon request (Tylenol 3). Pain data were assessed using one-way analysis of variance and the Duncan multiple range test (alpha = 0.05). At all postoperative intervals, the greatest pain scores were recorded in the control group. Statistically significant differences in pain scores were found at the 4-, 6-, 8-, and 10-hr postoperative intervals. At the 2-hr postoperative interval, pain had increased in all groups, but no differences were found among the groups. At the 4- and 6-hr interval, pain levels in Group I were significantly greater than those in Group II and Group IV, with Group III and IV not significantly different from Group II. At 10 hr, pain levels in the saline group were significantly greater than those in all the other groups. At all intervals, the only significant differences detected were found between the control group and the experimental groups; no significant differences were found at any point among any of the experimental groups. The relationship between the number of doses of narcotic medication taken postoperatively, and the preoperative intravenous regimen was assessed with a Kruskal-Wallis test. No significant difference was found among groups with respect to the need for postoperative pain medication (P > 0.05). Postoperative analgesia following third molar surgery was enhanced in the first 10 hr with the preoperative administration of ketorolac. The addition of dexamethasone did not improve the analgesic effect.