Dipyrone versus acetaminophen in the control of postoperative pain
Dipirona versus paracetamol no controle da dor pós-operatória
Queiroz, Thallita Pereira; Santos, Pâmela Letícia dos; Esteves, Jônatas Caldeira; Stellin, Gustavo Marco; Shimizu, Aline Sayuri; Junior, Walter Betoni; Vieira, Eduardo Hochuli
http://dx.doi.org/10.1590/S1807-25772013000200002
Rev. odontol. UNESP, vol.42, n2, p.78-82, 2013
Abstract
The pain is defined as an unpleasant experience, and control of postoperative pain a great challenge in healthcare. Objective: To compare the efficacy of Dipyrone and acetaminophen in postoperative pain after third molar surgery. Material and method: Thirty patients of the Discipline of Surgery of School of Dentistry of Araçatuba - UNESP, that needed to extract their third included molars, were selected. Among these, 15 received Dipyrone (group I) and the other received acetaminophen (group II) in the postoperative. All patients were treated pre-operatively with dexamethasone 4 mg and amoxycillin 1 g, one hour before surgery. Pain intensity was evaluated by a visual analogue scale by forty eight hours postoperative period and in intervals of six hours. The exclusion criteria were: presence of systemic disorders, drugs hypersensitivity, pregnant, lactic and local contraindications. The scores obtained were submitted to the Mann-Whitney test (p < 0,05) for comparison of the pain intensity in the 6 hours intervals, in the initial 24 hours, in the last 24 hours and in the total period of 48 hours. Result: There was no statistical difference among the analgesics in the 6 hours intervals, however, in the last 24 hours and in the total period of 48 hours, the group I presented smaller medium values, significant statistically, when compared to group II. Conclusion: The analgesic efficacy of dipyrone was superior to paracetamol.
Keywords
Analgesia, molar, third, acetaminophen, dipyrone.
Resumo
A dor é definida como uma experiência desagradável, sendo o controle da dor pós-operatória um grande desafio na área da saúde. Objetivo: Comparar a eficácia da dipirona e do paracetamol no controle da dor pós-operatória após exodontia de terceiros molares inclusos. Material e método: Foram selecionados 30 pacientes da Disciplina de Cirurgia da Faculdade de Odontologia de Araçatuba – UNESP, que necessitavam extrair os terceiros molares inclusos. Desses, 15 receberam dipirona (Grupo I) e outros 15 receberam paracetamol (Grupo II) no pós‑operatório. Todos os pacientes foram tratados, no pré-operatório, uma hora antes do procedimento cirúrgico, com dexametasona 4 mg e amoxicilina 1 grama. A intensidade da dor foi avaliada pelos pacientes por meio de escala visual analógica, em um período pós-operatório de 48 horas, em intervalos de 6 horas. Os critérios de exclusão foram: presença de desordens sistêmicas, hipersensibilidade medicamentosa, gestação, lactação e contraindicações locais. Os escores obtidos foram submetidos ao teste de Mann-Whitney (α = 0,05) para comparação das intensidades de dor em intervalos de 6 horas, nas 24 horas iniciais, nas 24 horas finais e no período total de 48 horas. Resultado: Não houve diferença estatística entre os analgésicos estudados nos intervalos de 6 horas; entretanto, nas 24 horas finais e nas 48 horas totais de observação, o Grupo I apresentou valores médios menores, estatisticamente significantes, quando comparado ao Grupo II. Conclusão: A eficácia analgésica da dipirona foi superior à do paracetamol.
Palavras-chave
Analgesia, terceiro molar, acetaminofen, dipirona.
Referências
1. Andrade ED. Terapêutica medicamentosa em odontologia. 2ª ed. São Paulo: Artes Médicas; 2000.
2. Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A. Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth. 2008; 20(2): 103-8. PMid:18410864. http://dx.doi.org/10.1016/j.jclinane.2007.09.009
3. Berge TI. Pattern of self-administered paracetamol and codeine analgesic consumption after third-molar surgery. Acta Odontol. Scand. 1997; 55 (5):270-6. PMid:9370023. http://dx.doi.org/10.3109/00016359709114963
4. Planas ME, Gay-Escoda C, Bagán JV, Santamaría J, Peñarrocha M, Donado M. Oral metamizol (1 g and 2 g) versus ibuprofen and placebo in the treatment of lower third molar surgery pain: randomised, double-blind multicenter study. Eur J Clin Pharmacol. 1998; 53 (6):405-9. PMid:9580448. http://dx.doi.org/10.1007/s002280050400
5. Sisk AL, Mosley RO, Martin RP. Comparison of preoperative and postoperative diflunisal for suppression of postoperative pain. J Oral Maxillofac Surg. 1989; 47(5): 464-8. http://dx.doi.org/10.1016/0278-2391(89)90278-4
6. Goodman AG. As bases farmacológicas da terapêutica. 8ª ed. Rio de Janeiro: Guanabara Koogan; 1991.
7. Moore A, Collins S, Carroll D, McQuay H, Edwards J. Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. Cochrane Database Syst Rev. 2009;1: CD001547. PMid:19160199.
8. Weil K, Hooper L, Afzal Z, Esposito M, Worthington HV, van Wijk AJ. Paracetamol for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2007; 3: CD004487. PMid:17636762.
9.Högestätt ED, Jönsson BA, Ermund A, Andersson DA, Björk H, Alexander JP, et al. Conversion of acetaminophen to the bioactive N-acylphenolamine AM404 via fatty acid amide hydrolase-dependent arachidonic acid conjugation in the nervous system. J Biol Chem. 2005; 280(36):31405-12. PMid:15987694. http://dx.doi.org/10.1074/jbc.M501489200
10. Escobar W, Ramirez K, Avila C, Limongi R, Vanegas H, Vazquez E. Metamizol, a non-opioid analgesic, acts via endocannabinoids in the PAG-RVM axis during inflammation in rats. Eur J Pain. 2012 May;16(5):676-89 PMid:22337336. http://dx.doi.org/10.1002/j.1532-2149.2011.00057.x
11. Edwards J, Meseguer F, Faura C, Moore RA, McQuay HJ, Derry S. Single-dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev. 201; 9: CD003227.
12. Rezende RM, França DS, Menezes GB, dos Reis WG, Bakhle YS, Francischi JN. Different mechanisms underlie the analgesic actions of paracetamol and dipyrone in a rat model of inflammatory pain. Br J Pharmacol. 2008;153(4):760-8. PMid:18157167 PMCid:2259218. http://dx.doi.org/10.1038/sj.bjp.0707630
13. Andrade SE., Martinez C, Walker AM. Comparative safety evaluation of non-narcotic analgesics. J Clin Epidemiol. 1998;.51(12):1357-65.
14. Noronha VR, Gurgel GD, Alves LC, Noman-Ferreira LC, Mendonça LL, Aguiar EG, et al. Analgenic efficacy of lysine clonixinate, paracetamol and dipyrine in lower third molar extraction. A randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2009;14(8):e411-25. PMid:19415056.
15. Quiding H, Persson G, Ahlström U, Bångens S, Hellem S, Johansson G. Paracetamol plus supplementary doses of codeine. An analgesic study of repeated doses. . Eur J Clin Pharmacol. 1982; 23( 4):315-9. PMid:6756936. http://dx.doi.org/10.1007/BF00613612
16. Ahlström U, Fåhraeus J, Quiding H, Ström C. Multiple doses of paracetamol plus codeine taken immediately after oral surgery. Eur J Clin Pharmacol. 1985; 27(6): 693-6. PMid:3886395. http://dx.doi.org/10.1007/BF00547051
17. Sagne S, Henrikson PA, Kahnberg KE, Thilander H, Bertilson SO. Analgesic efficacy and side-effect profile and parcetamol/codeine and paracetamol/dextropropoxiphene after surgical removal of a lower wisdom tooth. J Int Med Res. 1987;15(2):83-8. PMid:3556263.
18. Habib S, Matthews RW, Scully C, Levers BG, Shepherd JP. A study of the comparative efficacy of four common analgesics in the control of postoperative dental pain. Oral Surg Oral Med Oral Pathol. 1990;70(5):559-63. http://dx.doi.org/10.1016/0030-4220(90)90396-A
19. Nørholt SE, Aagaard E, Svensson P, Sindet-Pedersen S. Evaluation of trismus, bite force and pressure algometry after third molar surgery: a placebo-controlled study of ibuprofen. J Oral Maxillofac Surg. 1998; 56(4): 420-7. http://dx.doi.org/10.1016/S0278-2391(98)90705-4
20. Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment. Best Pract Res Clin Anaesthesiol 2007; 2(1): 15-30. http://dx.doi.org/10.1016/j.bpa.2006.12.002
21. Grundmann U,Wörnle C, Biedler A, Kreuer S, Wrobel M, Wilhelm W. The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg. 2006; 103 (1):217-22. PMid:16790656. http://dx.doi.org/10.1213/01.ane.0000221438.08990.06
22. Landwehr S, Kiencke P, Giesecke T, Eggert D, Thumann G, Kampe S. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery. Curr Med Res Opin. 2005 ; 21(10):1569-75. PMid:16238896. http://dx.doi.org/10.1185/030079905X61857
23. Van Buren J, Kleinknecht RA. An evaluation of the Mcgill Pain Questionaire for use in dental pain assessment. Pain. 1979; 6(1):23-33. http://dx.doi.org/10.1016/0304-3959(79)90137-4
24. Seymour RA, Meechan JG., Blair GS. An investigation into postoperative pain after third molar surgery under local analgesia. Br J Oral Maxillofac Surg. 1985; 13(6): 410-8. http://dx.doi.org/10.1016/0266-4356(85)90025-7
25. Seymour RA, Walton JG. Pain control after third molar surgery. Int J Oral Surg. 1984; 13(6):357-485. http://dx.doi.org/10.1016/S0300-9785(84)80017-4
26. Gómez-Jiménez J, Franco-Patino R, Chargoy-Vera J, Olivares-Sosa R. Clincal efficacy of mild analgesics in pain following gynaecological or dental surgery: Report on multicentre studies. Br J Clin Pharmacol. 1980; 10( 2): 355-8 http://dx.doi.org/10.1111/j.1365-2125.1980.tb01823.x
27. Neumann J. Advise against metamizole. Dtsch Arztebl Int. 2009; 4:106.
28. Paeile C, Gallardo F. Analgesic activity of pentazocine and dypirone in ambulatory oral surgery patients. J Oral Surg. 1974; 32(3):191-4. PMid:4590709.