This study compared the analgesic efficacy of preemptive oral ketorolac with submucous tramadol (Group A) versus oral ketorolac with submucous placebo (Group B) for impacted mandibular third molar surgery. 40 patients received each treatment in a double-blind, split-mouth study. Group A reported significantly lower pain intensity scores from 1-12 hours post-op and had a longer pain-free interval compared to Group B. Group A also required less postoperative analgesics in the first 24 hours. While Group A reported more headaches, nausea and local reactions, preemptive oral ketorolac with tramadol provided superior pain relief after third molar surgery compared to
This study compared the analgesic efficacy of preemptive oral ketorolac with submucous tramadol (Group A) versus oral ketorolac with submucous placebo (Group B) for impacted mandibular third molar surgery. 40 patients received each treatment in a double-blind, split-mouth study. Group A reported significantly lower pain intensity scores from 1-12 hours post-op and had a longer pain-free interval compared to Group B. Group A also required less postoperative analgesics in the first 24 hours. While Group A reported more headaches, nausea and local reactions, preemptive oral ketorolac with tramadol provided superior pain relief after third molar surgery compared to
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
Ā
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
Ā
This study compared the efficacy of fixed versus removable retainers for maintaining orthodontic treatment outcomes over 4 years. 48 participants from an original randomized controlled trial were evaluated. Those with fixed retainers had lower irregularity scores on average (0.85mm increase) compared to removable retainers (1.47mm increase). After adjusting for confounding factors, the difference in irregularity between groups was statistically significant, with removable retainers having 1.64mm more irregularity on average. No other significant differences were found between groups for other metrics like inter-canine width. Compliance with removable retainers decreased over time. Fixed retainers maintained their position better, though some required repair. In conclusion, fixed retainers appeared to
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
Ā
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
This study compared the analgesic efficacy of preemptive oral ketorolac with submucous tramadol (Group A) versus oral ketorolac with submucous placebo (Group B) for impacted mandibular third molar surgery. 40 patients received each treatment in a double-blind, split-mouth study. Group A reported significantly lower pain intensity scores from 1-12 hours post-op and had a longer pain-free interval compared to Group B. Group A also required less postoperative analgesics in the first 24 hours. While Group A reported more headaches, nausea and local reactions, preemptive oral ketorolac with tramadol provided superior pain relief after third molar surgery compared to
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
Ā
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
Ā
This study compared the efficacy of fixed versus removable retainers for maintaining orthodontic treatment outcomes over 4 years. 48 participants from an original randomized controlled trial were evaluated. Those with fixed retainers had lower irregularity scores on average (0.85mm increase) compared to removable retainers (1.47mm increase). After adjusting for confounding factors, the difference in irregularity between groups was statistically significant, with removable retainers having 1.64mm more irregularity on average. No other significant differences were found between groups for other metrics like inter-canine width. Compliance with removable retainers decreased over time. Fixed retainers maintained their position better, though some required repair. In conclusion, fixed retainers appeared to
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
Ā
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
Marginal and Internal Fit of Different Fixed Dental Prostheses: A Comparative...DrHeena tiwari
Ā
This study compared five methods for assessing the marginal and internal fit of fixed dental prostheses: the cross-sectional method, silicone replica technique, triple scan method, micro-computed tomography, and optical coherence tomography. Measurements of the marginal gap, axial gap, angle gap, and occlusal gap found statistically significant differences between the methods. The cross-sectional method and silicone replica technique showed the lowest mean values and were the most similar, while the triple scan method and optical coherence tomography also showed similarities. The study concluded that while fit values may fall within clinically acceptable ranges, differences between assessment methods should be considered.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 25th publication IJCAR 1st name
Radiographic Evaluation of the MB2 Canal in Permanent Maxillary Molars- An Or...DrHeena tiwari
Ā
This study evaluated the presence and location of the MB2 canal in maxillary first molars using CBCT scans. The scans of 296 patients were analyzed, showing MB2 canals in 43.8% of teeth. No significant gender difference was found. The angle between the mesiobuccal, distobuccal and palatal canals (ĘMDP) was greater in teeth with MB2 canals. A moderate positive correlation was found between ĘMDP and the angle between mesiobuccal, distobuccal and MB2 canals (ĘMDMB2). If ĘMDP was over 90.95 degrees, there was a 78% probability of finding an
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
Ā
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Effectiveness of Low-Level Lasers in the Management of Recurrent Aphthous Sto...DrHeena tiwari
Ā
This study assessed the effectiveness of low-level lasers in treating recurrent aphthous stomatitis. 30 subjects with minor, major, or herpetiform aphthae were treated with lasers and their pain was evaluated using VAS scores. For all groups, pain was significantly less after 24 hours and further reduced at 72 hours compared to pre-treatment levels. At 1 week, pain scores were minimal or zero. The results demonstrated that low-level lasers provide effective pain relief and accelerated healing for recurrent aphthous stomatitis lesions.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
Ā
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
This document summarizes a study that compared the effectiveness of serratiopeptidase and dexamethasone in reducing swelling after surgical removal of impacted third molars. The study involved 100 patients randomized into two groups, with one group receiving dexamethasone and the other receiving serratiopeptidase. Facial measurements were taken preoperatively and on postoperative days 1, 2, 5, and 7. The results showed that serratiopeptidase was effective in reducing swelling from days 2 to 5, while dexamethasone was effective in reducing swelling from days 1 to 2 and also from days 2 to 5. Dexamethasone was found to be more effective than serratiopeptidase in reducing postoperative swelling
Regenerative Surgical Treatment of Furcation Journal PresentationDr. B.V.Parvathy
Ā
AIM
To evaluate the performance and the added values of surgical regenerative techniques in terms of tooth loss, furcation closure/conversion, horizontal bone level gain and other periodontal parameters of teeth affected by periodontitis-related furcation defects, at least 12 months after surgery.
This study compared the frequency of post-operative adhesions in 62 patients undergoing endoscopic sinus surgery who received either an intranasal silastic splint plus anterior nasal packing (Group A) or anterior nasal packing alone (Group B). The frequency of post-operative adhesions was significantly lower in Group A (0%) compared to Group B (16.1%). Across age, gender, and symptom duration subgroups, adhesion rates remained significantly lower in patients receiving silastic splints. The study concludes that silastic splints are effective in reducing post-operative adhesions after endoscopic sinus surgery.
This study evaluated the efficacy of two different root canal sealers - AH Plus and MTA Fillapex - in strengthening teeth during endodontic therapy. 75 single-rooted teeth were instrumented and divided into 3 groups: Group A used AH Plus sealer, Group B used MTA Fillapex sealer, and Group C was unfilled. Obturated teeth were embedded in resin and force was applied until fracture. Teeth filled with AH Plus required the most force (235.9N) to fracture, followed by MTA Fillapex (168.5N), with unfilled teeth fracturing at the least force (90.7N). The authors concluded that AH Plus provided greater strength than
i-prf &MN in gingival augmentation in thin phenotypeDr. B.V.Parvathy
Ā
To evaluate the effect of gingival thickness (GT) and keratinized tissue width (KTW) using injectable platelet rich fibrin (i-PRF) alone and with microneedling (MN) in individuals with thin periodontal phenotypes.
Background: Many new brands of Hyaluronic acid (HA) fillers are being produced, and the longevity and safety are always major concern about HA fillers.
Objective: To evaluate the efficacy, tolerability, and safety of touch-up treatment of a HA filler, ElravieĀ® deep line which is used for correcting nasolabial folds (NLFs).
Methods: The rheological property values of HA fillers were measured using a rheometer.A total of 50 subjects with visible NLFs were enrolled in this clinical study and were divided into test and control groups. All subjects were injected with same amount of HA in both NLFs and only the test group had touch-up treatment after 9 months of first injection. All participants were then reassessed for cosmetic changes using Wrinkle Severity Rating Scale (WSRS) and Global aesthetic improvement scale (GAIS).
This meta-analysis evaluates the reliability of published evidence on regenerative endodontic procedures. It summarizes clinical and radiographic findings from studies on treating non-vital immature permanent teeth using regenerative techniques. The analysis finds good success rates for tooth survival and pathology resolution, but variable results for outcomes like apex closure and root development. Regenerative procedures are improving but factors important for success remain unclear, indicating more research is needed.
MB2 In Maxillary Second Molar ā Two Case ReportsQUESTJOURNAL
Ā
This document presents two case reports of maxillary second molars that each had an extra canal (MB2) identified in the mesiobuccal root. In the first case, careful visualization with magnifying loupes revealed a groove indicating the presence of an MB2 canal, which was located using an ultrasonic tip. In the second case, an incomplete access cavity was modified and exploration uncovered an extra mesiobuccal canal. Both cases were treated with biomechanical preparation and obturation of all canals. Failure to locate and treat extra canals such as MB2 is a common reason for endodontic treatment failure.
Pregabalin is an effective and safe adjuvant for reducing chronic
post-thoracotomy pain, without significant side effects, in all age
groups and either gender. The pain relief becomes statistically
significant after three weeks of treatment and it continues till six
months. However, larger randomized and placebo-controlled trials
of longer durations are required to further validate these findings.
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
Ā
In a randomized double-blind study, researchers compared the efficacy of granisetron versus metoclopramide for preventing postoperative nausea and vomiting (PONV) in 50 female patients undergoing major gynecological surgery. Patients received either granisetron 40mcg/kg or metoclopramide 0.15mg/kg before surgery. Incidence of PONV was assessed over 24 hours. While both drugs effectively prevented PONV in the first 4 hours, granisetron was more effective over the next 20 hours, with a 12% incidence of PONV versus 48% for metoclopramide. Nausea scores were also significantly lower in the granisetron group
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
Ā
In a randomized double-blind study, researchers compared the efficacy of granisetron versus metoclopramide for preventing postoperative nausea and vomiting (PONV) in 50 female patients undergoing major gynecological surgery. Patients received either granisetron 40mcg/kg or metoclopramide 0.15mg/kg before surgery. Incidence of PONV was assessed over 24 hours. While both drugs effectively prevented PONV in the first 4 hours, granisetron was more effective over the next 20 hours, with a 12% incidence of PONV versus 48% for metoclopramide. Nausea scores were also significantly lower in the granisetron group
Marginal and Internal Fit of Different Fixed Dental Prostheses: A Comparative...DrHeena tiwari
Ā
This study compared five methods for assessing the marginal and internal fit of fixed dental prostheses: the cross-sectional method, silicone replica technique, triple scan method, micro-computed tomography, and optical coherence tomography. Measurements of the marginal gap, axial gap, angle gap, and occlusal gap found statistically significant differences between the methods. The cross-sectional method and silicone replica technique showed the lowest mean values and were the most similar, while the triple scan method and optical coherence tomography also showed similarities. The study concluded that while fit values may fall within clinically acceptable ranges, differences between assessment methods should be considered.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 25th publication IJCAR 1st name
Radiographic Evaluation of the MB2 Canal in Permanent Maxillary Molars- An Or...DrHeena tiwari
Ā
This study evaluated the presence and location of the MB2 canal in maxillary first molars using CBCT scans. The scans of 296 patients were analyzed, showing MB2 canals in 43.8% of teeth. No significant gender difference was found. The angle between the mesiobuccal, distobuccal and palatal canals (ĘMDP) was greater in teeth with MB2 canals. A moderate positive correlation was found between ĘMDP and the angle between mesiobuccal, distobuccal and MB2 canals (ĘMDMB2). If ĘMDP was over 90.95 degrees, there was a 78% probability of finding an
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
Ā
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Effectiveness of Low-Level Lasers in the Management of Recurrent Aphthous Sto...DrHeena tiwari
Ā
This study assessed the effectiveness of low-level lasers in treating recurrent aphthous stomatitis. 30 subjects with minor, major, or herpetiform aphthae were treated with lasers and their pain was evaluated using VAS scores. For all groups, pain was significantly less after 24 hours and further reduced at 72 hours compared to pre-treatment levels. At 1 week, pain scores were minimal or zero. The results demonstrated that low-level lasers provide effective pain relief and accelerated healing for recurrent aphthous stomatitis lesions.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
Ā
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
This document summarizes a study that compared the effectiveness of serratiopeptidase and dexamethasone in reducing swelling after surgical removal of impacted third molars. The study involved 100 patients randomized into two groups, with one group receiving dexamethasone and the other receiving serratiopeptidase. Facial measurements were taken preoperatively and on postoperative days 1, 2, 5, and 7. The results showed that serratiopeptidase was effective in reducing swelling from days 2 to 5, while dexamethasone was effective in reducing swelling from days 1 to 2 and also from days 2 to 5. Dexamethasone was found to be more effective than serratiopeptidase in reducing postoperative swelling
Regenerative Surgical Treatment of Furcation Journal PresentationDr. B.V.Parvathy
Ā
AIM
To evaluate the performance and the added values of surgical regenerative techniques in terms of tooth loss, furcation closure/conversion, horizontal bone level gain and other periodontal parameters of teeth affected by periodontitis-related furcation defects, at least 12 months after surgery.
This study compared the frequency of post-operative adhesions in 62 patients undergoing endoscopic sinus surgery who received either an intranasal silastic splint plus anterior nasal packing (Group A) or anterior nasal packing alone (Group B). The frequency of post-operative adhesions was significantly lower in Group A (0%) compared to Group B (16.1%). Across age, gender, and symptom duration subgroups, adhesion rates remained significantly lower in patients receiving silastic splints. The study concludes that silastic splints are effective in reducing post-operative adhesions after endoscopic sinus surgery.
This study evaluated the efficacy of two different root canal sealers - AH Plus and MTA Fillapex - in strengthening teeth during endodontic therapy. 75 single-rooted teeth were instrumented and divided into 3 groups: Group A used AH Plus sealer, Group B used MTA Fillapex sealer, and Group C was unfilled. Obturated teeth were embedded in resin and force was applied until fracture. Teeth filled with AH Plus required the most force (235.9N) to fracture, followed by MTA Fillapex (168.5N), with unfilled teeth fracturing at the least force (90.7N). The authors concluded that AH Plus provided greater strength than
i-prf &MN in gingival augmentation in thin phenotypeDr. B.V.Parvathy
Ā
To evaluate the effect of gingival thickness (GT) and keratinized tissue width (KTW) using injectable platelet rich fibrin (i-PRF) alone and with microneedling (MN) in individuals with thin periodontal phenotypes.
Background: Many new brands of Hyaluronic acid (HA) fillers are being produced, and the longevity and safety are always major concern about HA fillers.
Objective: To evaluate the efficacy, tolerability, and safety of touch-up treatment of a HA filler, ElravieĀ® deep line which is used for correcting nasolabial folds (NLFs).
Methods: The rheological property values of HA fillers were measured using a rheometer.A total of 50 subjects with visible NLFs were enrolled in this clinical study and were divided into test and control groups. All subjects were injected with same amount of HA in both NLFs and only the test group had touch-up treatment after 9 months of first injection. All participants were then reassessed for cosmetic changes using Wrinkle Severity Rating Scale (WSRS) and Global aesthetic improvement scale (GAIS).
This meta-analysis evaluates the reliability of published evidence on regenerative endodontic procedures. It summarizes clinical and radiographic findings from studies on treating non-vital immature permanent teeth using regenerative techniques. The analysis finds good success rates for tooth survival and pathology resolution, but variable results for outcomes like apex closure and root development. Regenerative procedures are improving but factors important for success remain unclear, indicating more research is needed.
MB2 In Maxillary Second Molar ā Two Case ReportsQUESTJOURNAL
Ā
This document presents two case reports of maxillary second molars that each had an extra canal (MB2) identified in the mesiobuccal root. In the first case, careful visualization with magnifying loupes revealed a groove indicating the presence of an MB2 canal, which was located using an ultrasonic tip. In the second case, an incomplete access cavity was modified and exploration uncovered an extra mesiobuccal canal. Both cases were treated with biomechanical preparation and obturation of all canals. Failure to locate and treat extra canals such as MB2 is a common reason for endodontic treatment failure.
Pregabalin is an effective and safe adjuvant for reducing chronic
post-thoracotomy pain, without significant side effects, in all age
groups and either gender. The pain relief becomes statistically
significant after three weeks of treatment and it continues till six
months. However, larger randomized and placebo-controlled trials
of longer durations are required to further validate these findings.
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
Ā
In a randomized double-blind study, researchers compared the efficacy of granisetron versus metoclopramide for preventing postoperative nausea and vomiting (PONV) in 50 female patients undergoing major gynecological surgery. Patients received either granisetron 40mcg/kg or metoclopramide 0.15mg/kg before surgery. Incidence of PONV was assessed over 24 hours. While both drugs effectively prevented PONV in the first 4 hours, granisetron was more effective over the next 20 hours, with a 12% incidence of PONV versus 48% for metoclopramide. Nausea scores were also significantly lower in the granisetron group
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
Ā
In a randomized double-blind study, researchers compared the efficacy of granisetron versus metoclopramide for preventing postoperative nausea and vomiting (PONV) in 50 female patients undergoing major gynecological surgery. Patients received either granisetron 40mcg/kg or metoclopramide 0.15mg/kg before surgery. Incidence of PONV was assessed over 24 hours. While both drugs effectively prevented PONV in the first 4 hours, granisetron was more effective over the next 20 hours, with a 12% incidence of PONV versus 48% for metoclopramide. Nausea scores were also significantly lower in the granisetron group
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
A prospective, randomized, double blind study to evaluate Morphine sparing ef...iosrjce
Ā
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The preoperative administration of low doses of ketamine and clonidine before induction anesthesia appeared to provide benefits in morbidly obese patients undergoing open bariatric surgery. Patients receiving ketamine and clonidine required less sevoflurane, lower doses of fentanyl, and had a shorter time to tracheal extubation compared to controls. They also consumed less tramadol postoperatively and reported less pain in the first 6 hours based on visual analog scale scores. The combination of ketamine and clonidine allowed for reduced doses of anesthetic drugs while improving postoperative recovery outcomes.
This document describes a research study protocol to evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to levobupivacaine spinal anesthesia for abdominal hysterectomy. The study will randomly assign 104 patients to receive either levobupivacaine with normal saline or levobupivacaine with 10 Ī¼g dexmedetomidine intrathecally. The primary outcomes will be postoperative analgesia duration measured by VAS scores and time to first rescue analgesic. Secondary outcomes include sensory and motor block durations and any intraoperative hemodynamic changes or side effects. Standard protocols will be followed for preoperative, intraoperative and postoperative care.
More harm than benefit of perioperative dexamethasone on recovery following ...Dibya Falgoon Sarkar
Ā
1. A prospective double-blind randomized trial found that perioperative dexamethasone provided minor pain relief but significantly increased insulin requirements and risk of infections in patients undergoing reconstructive head and neck cancer surgery.
2. Dexamethasone did not accelerate recovery or shorten hospital stay and its use in head and neck cancer reconstruction provided no clear clinical benefits while increasing complications.
3. A randomized controlled trial of corticosteroids after transoral robotic surgery found extended perioperative dexamethasone was safe and may allow for earlier improvement in diet consistency and decreased hospital stay, though it minimally affected postoperative pain.
Analgeic eficacy /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Ā
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
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Dexmedetomidine and dexamethasone were compared as adjuvants to intrathecal bupivacaine for lower limb surgery. Dexmedetomidine prolonged the duration of spinal anesthesia and postoperative analgesia more than dexamethasone or saline control. It provided longer time to first analgesic request and less total analgesic consumption than the other groups. Dexmedetomidine also had higher patient satisfaction with pain control.
āA Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with C...iosrjce
Ā
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
This study compared the efficacy of amoxicillin vs amoxicillin-clavulanate in preventing infections after third molar extractions. 546 patients received either amoxicillin (1g) or amoxicillin-clavulanate (875/125mg) for 7 days post-op. There was no significant difference in infection rates between groups. However, the amoxicillin-clavulanate group had significantly higher rates of gastrointestinal side effects. Both antibiotics were similarly effective at preventing infections, but amoxicillin had fewer side effects, so the study concluded amoxicillin is preferable for post-op prophylaxis after
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
Ā
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30Āµg, Group-D: Dexmedetomidine 5 Āµg, Group-F: Fentanyl 25 Āµg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
8. Intra articular Tramadol and morphine articledrajun
Ā
This study compared the analgesic effects of intra-articular tramadol versus intra-articular morphine in 60 patients undergoing arthroscopic knee surgery. Patients were randomly assigned to receive either 50mg of tramadol or 5mg of morphine via intra-articular injection at the conclusion of surgery. Pain was assessed using a visual analogue scale at various time points post-operatively. The study found no significant differences in pain scores between the two groups at any time point. However, the tramadol group required less supplemental oral analgesics than the morphine group at the 6 hour post-operative time point. No other clinically significant differences, such as side effects, were observed between the groups. The study concluded that 50mg
Application of Pstim in Clinical Practice MaxiMedRx
Ā
The P-Stim and ANSiStimā¢ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStimā¢ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStimā¢ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStimā¢ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
This case report describes an unusual case of pseudo-ankylosis in an 8-year-old child with a history of trauma. Imaging revealed an old fractured right condyle that had been anteriorly displaced and dislocated into the sigmoid notch, where it had fused to the zygomatic arch. Computed tomography with 3D reconstruction clearly showed the displaced condylar fragment. The child underwent surgery to release the ankylotic mass and perform a coronoidectomy to improve mouth opening. Post-operatively, aggressive physiotherapy helped increase the child's maximum interincisal opening. This unique case highlights the importance of accurate imaging and diagnosis for successful treatment of complex facial injuries.
This document provides information about the editors and contributors of the book "Oral and Maxillofacial Surgery for the Clinician". It begins with an introduction by the editors explaining the motivation and scope of the book. It aims to be a comprehensive textbook on oral and maxillofacial surgery for clinicians and trainees. The book has contributions from AOMSI members in India as well as 41 international authors to represent global expertise. It contains 22 sections and 88 chapters covering all aspects of cranio-maxillofacial surgery, along with 68 video demonstrations. The editors thank the contributors and AOMSI for their support in producing this open access textbook.
Here are the key points about suction:
- The objective of suction is to maintain a clear airway by removing secretions like saliva, blood or vomit from the mouth or surgical site.
- It prevents aspiration which can lead to infections. Suction also helps surgeons see clearly during procedures.
- Safety considerations include using proper technique to avoid injury, knowing which patients are at risk of aspiration, monitoring for respiratory distress, and addressing other potential causes of distress beyond just secretions.
This document provides an introduction to mixed dentition space analysis. It discusses that during the mixed dentition period, there may be discrepancies between the space available in the dental arches and the size of the teeth. Accurate mixed dentition space analysis is important for orthodontic diagnosis and treatment planning. The document outlines that mixed dentition typically lasts from ages 6 to 12 years and is when maximum orthodontic problems can develop due to inadequate space for permanent teeth. It also categorizes different methods for mixed dentition space analysis, including those based on regression equations using measurements of erupted permanent teeth and those using radiographs.
This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with sodium hypochlorite with clotrimaz
This document discusses the importance of adult immunization and provides guidelines for vaccination against various diseases. It begins by noting that while childhood immunization is well-known, adult immunization is less understood but still important. It then reviews literature on vaccination protocols for adults, including for travel, communicable diseases, hepatitis B, shingles, and more. The document focuses in depth on recommended vaccination for human papillomavirus (HPV), hepatitis, and human immunodeficiency virus (HIV). It provides vaccination schedules, target groups, and notes the need to increase awareness of adult immunization among healthcare professionals and the public.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
- The document discusses animal models that are being used to test vaccines for COVID-19. It conducted a systematic review of studies published between January and August 2020.
- The review identified 20 relevant studies examining nonhuman primates, mice, hamsters, ferrets, cats and dogs. These animal models show some similar responses to SARS-CoV-2 infection as humans such as respiratory symptoms.
- However, the models do not fully mimic the severe complications seen in human COVID-19 patients such as acute respiratory distress syndrome and coagulopathy. While the models provide useful information, they have limitations in replicating the full disease severity in humans.
This study aimed to evaluate the knowledge and concerns of 124 dental health professionals in southern India regarding COVID-19. A survey was administered to assess understanding of COVID-19 transmission, oral manifestations, appropriate testing and emergency procedures. The results found good knowledge of COVID-19 and precautions, but some lack of awareness regarding appropriate testing and managing contaminated air. While most respondents understood transmission risks and emergency protocols, there was uncertainty around testing patients and using mouthwashes as prevention. This highlights gaps in knowledge that could be addressed with further education for dental professionals on COVID-19 clinical guidelines.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
A 34-year-old male presented with pain and pus discharge from a recently extracted tooth. Radiographs showed two distinct radiolucencies - a large cyst in the left mandible and a smaller cyst in the right mandible. Histological examination found the left cyst to be a radicular cyst and the right cyst to be a dentigerous cyst. This presented a diagnostic dilemma as it is uncommon to have multiple cyst types occurring bilaterally in the mandible without an associated syndrome. Careful radiographic and histological analysis was needed to arrive at the accurate diagnosis and appropriate treatment.
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Ā
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
Ā
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Ā
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing andĀ interpreting numerical data to assist in making more effective decisions.
Ā A statistics isĀ a measure which is used to estimate the population parameter
Ā Parameters-It is used to describe theĀ properties of an entire population.
Examples-Measures of central tendency Dispersion,Ā Variance,Ā Standard Deviation (SD), Absolute Error,Ā Mean Absolute Error (MAE), Eigen Value
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us:Ā https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
Ā
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
PGx Analysis in VarSeq: A Userās PerspectiveGolden Helix
Ā
Since our release of the PGx capabilities in VarSeq, weāve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your labās goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
1. ORIGINAL ARTICLE
Preemptive Oral Ketorolac with Local Tramadol Versus Oral
Ketorolac in Third Molar Surgery: A Comparative Clinical Trial
Heena Mazhar1 ā¢ Ratna Samudrawar2 ā¢ Prashant Tamgadge1 ā¢ Rashmi Wasekar3 ā¢
Rahul Vinay Chandra Tiwari4 ā¢ Heena Tiwari5
Received: 7 August 2019 / Accepted: 19 June 2020
The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract
Aims To assess preemptive analgesic efficacy of oral
ketorolac with submucous placebo versus oral ketorolac
with submucous tramadol during impacted mandibular
third molar surgery.
Methodology A double-blind, split-mouth clinical study
was carried on 40 patients having bilateral impacted
mandibular third molars. They were divided as group A
comprising of 40 patients in whom oral ketorolac with
submucous tramadol was administered and group B com-
prising of 40 patients in whom oral ketorolac with sub-
mucous placebo was administered. The study parameters
included were pain intensity scores, duration to take 1st
rescue analgesia, need of analgesic intake during the first
24 h postoperatively and patientās experience.
Results The patientās experience was found to be better in
the group A as compared to group B while evaluating mean
pain intensity scores (VRS, VAS); need of postoperative
analgesics and drug-related complications.
Conclusion Preemptive oral ketorolac with tramadol in
comparison to oral ketorolac results in better pain relief,
longer pain free intervals with minimum rescue analgesics
requirement lesser postoperative analgesics
consumption.
Keywords Impacted third molars Ketorolac Preemptive
analgesics
Introduction
Surgical extraction of impacted mandibular third molar is
the most common minor surgical procedure which involves
mild to moderate trauma to bone, periosteum and muscles
causing postoperative algesia, edema and trismus. This
postoperative pain-induced anxiety makes the patient more
apprehensive by altering the harmony between circulatory
and endocrine system [1, 2]. The literature advocated
numerous drugs in various combinations via different
routes to achieve acceptable analgesia with minimum side
effects. [3ā6] Among the various modalities used, Non-
Steroidal Anti-Inflammatory Drugs (NSAIDs) are most
preferred due to their ease in availability and high patientās
compliance rate. However, it presents with a range of side
effects, the commonest being are gastrointestinal [7, 8].
Hence arises, the requirement of a new strategy which
efficiently reduces postoperative pain with reduction in
frequency of intake of NSAIDs in addition to reducing the
adverse effects [9, 10].
Crile noted that by inhibiting the pain transmission
before giving surgical incision using preemptive analgesia,
we can reduce the postoperative mortality as it prevents our
central nervous system to become hyper-excitable to
afferent inputs [11, 12]. Therefore, it enhances effective
Heena Mazhar
drheenatiwari@gmail.com
1
Department of Oral Maxillofacial Surgery, Chhattisgarh
Dental College and Research Institute, Rajnandgaon,
Chhattisgarh, India
2
Oral Medicine Radiology, EJHS Wellness Center,
Adilabad, Telangana, India
3
Department of Oral Medicine and Radiology, Swargiya
Dadasaheb Kalmegh Smruti Dental College and Hospital,
Wadhamna Road, Hingna, Nagpur, Maharashtra, India
4
Department of Oral and Maxillofacial Surgery, Sri Sai
College of Dental Surgery, Vikarabad, India
5
CHC Makdi, Kondagaon, Chhattisgarh, India
123
J. Maxillofac. Oral Surg.
https://doi.org/10.1007/s12663-020-01400-4
2. pain management with the minimum need of analgesic
requirements postoperatively [13, 14]. Ketorolac (NSAIDs)
is a potent analgesic with rapid onset of action, good oral
bioavailability, short duration of action in addition to
causing minimal gastrointestinal side effects [7, 15].
Tramadol is an opioid analgesic (synthetic codeine)
whose efficacy for mild to moderate pain was found
comparable to morphine. It shows 100% bioavailability on
intramuscular administration. But, its primary metabolite,
O-demethylated is two to four times more potent than the
parent drug and is responsible for its analgesic effect
[7, 16, 17]. This study is conducted to assess preemptive
analgesic efficacy of oral ketorolac with submucous pla-
cebo versus oral ketorolac with submucous tramadol dur-
ing impacted mandibular third molar surgery.
Methodology
In 40 patients belonging to the age group of 18ā30 years, a
double-blind, split-mouth placebo-controlled clinical study
was conducted after getting approval of the institutional
ethical committee. All patients who required surgical
removal of identical bilateral mandibular third molars,
during January 2015 to October 2016 were included. All
patients with ASA grade I category, having an asymp-
tomatic bilateral identical impacted mandibular third
molars along with grade II or III difficulty of extraction
were included. Following thorough case history, hemato-
logical and radiographic examination was performed for all
patients who satisfied the inclusion criteria. Written
informed consent was taken.
Those patients were excluded who failed to give written
informed consent for the study, having uncontrolled dia-
betes, peptic ulcers, Gastro-esophageal reflux disorder
(GERD), autoimmune disease, lactation or pregnant, under
oral contraceptive use, acute infections, history of seizure
disorder, respiratory disorders, impaired renal or hepatic
function, had taken analgesic 24 h prior to the surgical
procedure and known allergy to the drugs used in this
study.
The patients were randomly divided into two groups.
Each patient was tested for allergy to mixture of tra-
madol ? 2% lignocaine through subcutaneous injection of
test dose of 0.02ā0.05 ml under standard observation
technique, a wheal reaction of [ 3 mm would be consid-
ered hypersensitive and excluded from the study. All
patients are advised to undergo impaction surgery on two
separate visits with a refractory period of 1 month. They
were given preemptive analgesics 30 min before surgery,
{tramadol or a placebo (normal saline) are administered in
the same area using an insulin syringe} as per their groups
as follows: GROUP A: oral ketorolac 10 mg with
submucous local tramadol 50 mg (1 ml solution).GROUP
B: oral ketorolac 10 mg with submucous local placebo
(1 ml saline solution). In every patient one side belonged to
Group A and the other side belonged to Group B. (Figs. 3,
4).
ā¢ All surgical cases was done out by the single same
operator and postoperative parameters were assessed by
another investigator.
ā¢ After giving local anesthesia (2% Lignocaine with
1:80,000 adrenaline) study drugs were administered in
the same area using an insulin syringe.
After achieving adequate local anesthesia, incision was
given and following mucoperiosteal flap reflection, disto-
buccal bone guttering with rotary cutting instruments under
copious saline irrigation was done. Once tooth was
removed, smoothing of bone margins, wound toilet of
extraction socket with betadine and normal saline was
done. After achieving homeostasis, primary closure was
done using 3ā0 black braided silk suture.
Intraoperatively, time from giving incision to final
suturing was recorded. Following which immediate post-
operative medications and instructions was given to the
patient. The patients were given four oral ketorolac
(10 mg) tablets and were advised to have one tablet as
rescue analgesic and should be taken at 6 h interval only if
needed.
An evaluation format was given to each patient and
explained in their vernacular language about the markings
on the self-analysis pain performa, to document the time of
taking the first ketorolac after the surgery and also to
mention the total number of analgesic ketorolac 10 mg
consumed in the next 24 h. They were also asked to note
any postoperative complications like nausea; vomiting;
headache; dizziness; pain on injection of tramadol/saline;
erthyema; itching or other.
After assessment period of 24 h postoperative, the
patients had to return the unused ketorolac. The number of
consumed tablets was counted and noted. On the evening
of operative day, all the patients were evaluated for any
adverse events or symptoms, either from medications or
surgical procedures. Double blinding was done with the
patient and the investigator.
All patients recalled after 24 h to assess self assessment
Performa and for noting any local complications due to the
surgical procedure. The self analysis sheets will be asses-
sed and confirmed verbally. Pain scale will be evaluated
according to visual analog scale and verbal response scale
at 1st hour, 2nd hour, 3rd hour, 4th hour, 6th hour and at
12th hour postoperatively. After a week, suture removal
was done.
J. Maxillofac. Oral Surg.
123
3. Results
For the statistical analysis of the data, the SPSS version
16.0 was employed. Frequency distribution and Chi-square
tests at 95% confidence interval were calculated for ana-
lyzing the results. Z test, unpaired t test to find difference
between two means, v2
Chi-square test for comparison of
qualitative data between the groups were used.
Demographic features and other variables were found to
be similar among both the groups (Tables 1, 2). The
postoperative pain intensity scores according to Verbral
Response Scale (VRS) Table 3, Fig. 1. The patients
experienced significantly lower pain intensity scores from
1st to 12th postoperative hours with oral ketorolac plus
local tramadol in group A as compared to group B of oral
ketorolac plus local saline as placebo. (Table 3, Fig. 1)
According to Visual Analog Scale (VAS), both the
groups had nearly equal effect for up to 2 h postopera-
tively. But, at 3rd hour, highly significant pain relief was
noted which gradually persists to give a significant pain
Table 1 Age and genderwise
distribution of patients
Age Male Female Total Z value P value and significance
No. % No. % No. %
B 20 10 41.7 6 37.5 16 40.0 Z = 0.46 P [ 0.05, not significant
21ā25 10 41.7 9 56.2 19 47.5
26ā30 4 16.6 1 6.3 5 12.5
Total 24 100.0 16 100.0 40 100.0
Mean Ā± SD 22.30 Ā± 3.2 21.86 Ā± 3.1 22.10 Ā± 3.15
There is no statistical significance difference of age among males and females
Table 2 Duration of surgery
Duration of surgery in minutes Group A Group B Total Z value P value and significance
No. % No. % No. %
15ā20 8 41.7 7 37.5 15 40.0 Z = 0.43 P [ 0.05, not significant
21ā25 3 41.7 5 56.2 5 47.5
26ā30 10 16.6 10 6.3 20 12.5
31ā35 5 100.0 2 100.0 7 100.0
36ā40 6 100.0 8 100.0 14 100.0
[ 40 8 16.6 8 6.3 16 12.5
Total 40 100.0 40 100.0 80 100.0
Mean Ā± SD 32.15 Ā± 10.73 33.25 Ā± 10.25 32.70 Ā± 10.48
There is no statistical significance difference of duration of surgery in group A and group B
Table 3 Comparison of mean
pain intensity between the
groups using VRS
Time period Group A Group B t test values P value significant
Mean Ā± SD Mean Ā± SD
1st hour 0.8 Ā± 0.46 1.0 Ā± 0.22 t = 2.45 P = 0.017, S
2nd hour 1.0 Ā± 0.22 1.17 Ā± 0.44 t = 2.23 P = 0.030 S
3rd hour 1.47 Ā± 0.55 1.92 Ā± 0.57 t = 3.57 P = 0.001 HS
4th hour 2.17 Ā± 0.54 2.62 Ā± 0.54 t = 3.69 P = 0.000 HS
6th hour 2.57 Ā± 0.50 2.25 Ā± 0.49 t = 2.92 P = 0.005 S
12th hour 2.27 Ā± 0.45 2.57 Ā± 0.50 t = 2.82 P = 0.006 S
24th hour 2.2 Ā± 0.40 2.3 Ā± 0.46 t = 1.02 P = 0.308 NS
S significant, NS not significant, HS highly significant
J. Maxillofac. Oral Surg.
123
4. relief at hours 3rd, 4th, 6th postoperatively. (Table 4). It
means that patients reported a significantly lower pain
intensity scores at hours 3rd, 4th, 6th postoperatively in
group A as compared to group B.
The pain-free interval was found to be significantly
longer in the group A (6.96 Ā± 1.47 h) (highly significant
P 0.001) as compared to group B (4.59 Ā± 0.99 h) as
assessed by mean time to take first rescue analgesic.
(Fig. 2)
When total number of analgesic consumed in first 24 h
postoperatively were compared, a highly significant dif-
ference (P 0.001) was noticed with mean 1.29 Ā± 0.45
and 2.53 Ā± 0.66 for group A and group B, respectively.
This suggests that use of combination of analgesics (ke-
torolac ? tramadol) as preemptive analgesics proved
better than use of single analgesic (ketorolac) and needs
less consumption of analgesics postoperatively. (Table 5).
Complications like headache; nausea; vomiting; local
changes like itching, pain at injection site if experienced by
the patient were recorded. Headache were noticed in 5
patients of group A (12.5%) and in only one patient of
group B (2.5%). Whereas, 8 patients (20%) after injecting
tramadol complains of nausea and 3 patients (7.5%)
reported vomiting. They were prescribed antiemetic in
group A. Only 5 patients (12.5%) of group A had com-
pliant of local reactions like pain at injection site and 3
patients (7.5%) reported itching on tramadol injection as
compared to none of local reactions noted in group B.
(Fig. 3).
Fig. 1 Graph 1 showing
comparison of mean pain
intensity between the two
groups
Table 4 Comparison of mean
pain intensity between the
groups using VAS
Time period Group A Group B t test values P value significant
Mean Ā± SD Mean Ā± SD
1st hour 2.12 Ā± 0.33 2.12 Ā± 0.33 t = 0.04 P [ 0.05, P = 0.961 NS
2nd hour 2.71 Ā± 0.52 2.90 Ā± 0.80 t = 1.36 P [ 0.05, P = 0.157 NS
3rd hour 3.48 Ā± 1.07 4.59 Ā± 1.32 t = -3.818 P 0.001, P = 0.000 HS
4th hour 5.45 Ā± 1.62 6.50 Ā± 1.25 t = - 2.76 P 0.05, P = 0.012 S
6th hour 6.35 Ā± 1.57 5.35 Ā± 1.40 t = 2.278 P 0.05, P = 0.024 S
12th hour 5.45 Ā± 1.21 6.15 Ā± 1.20 t = 0.687 P 0.05, P = 0.494 NS
24th hour 5.22 Ā± 0.71 5.59 Ā± 1.02 t = - 1.54 P [ 0.05, P = 0.085 NS
S significant, NS not significant, HS highly significant
J. Maxillofac. Oral Surg.
123
5. Global assessment shows patients of group A, on 32
occasions of oral ketorolac with local tramadol treatment
and patients of group B, on 9 occasions of oral ketorolac
with local saline rated the overall surgical procedure as
good. (Fig. 4) There was statistically highly significance
difference of global assessment experienced between the
groups (P 0.001).
Discussion
Preemptive analgesia is an anti-nociceptive therapy to
block transmission of altered central processing of afferent
inputs from preoperative or intraoperative injuries (central
desensitization) which causes pain enhancement in post-
operative period. To attain its maximum effectiveness,
establishing an optimum level of analgesia before, during
and after injury period is necessary to reduce central sen-
sitization during inflammation [9, 10, 18].
Based on the intensity and severity of pain, a specific
analgesic drug can be chosen. The opioid and non-opioid
(NSAIDs) analgesic drugs mostly selected for moderate to
severe type of dental pain. Whereas, on reviewing litera-
ture, it had been shown that the combined usage of drugs
having different modes of action like morphine, meperidine
with NSAIDs gives more efficacy with even the reduced
dose of opioids and increases anti-nociceptive effects
[6, 19]. This was also proved in our study by the additive
agonism of oral ketorolac with local tramadol, reporting
increased pain free duration of 6.96 h postoperatively in
group A as compared to 4.59 h in group B where only oral
ketorolac was used. Thus, our study supports the syner-
gistic analgesic effective of ketorolac with tramadol as
suggested by various authors in the past.
[3ā5, 14, 15, 20ā22].
Fig. 2 Graph 2 showing
comparison of mean time of first
dose of rescue analgesia
between the groups
Table 5 Comparison of number of total analgesics consumed in 24 h
postoperatively between the groups
No. of doses Group A Group B
No of cases % No of cases %
1 28 70.0 0 0.0
2 11 27.5 22 55.0
3 1 2.5 14 35.0
4 0 0.0 4 10.0
Total 40 100.0 40 100.0
There is statistically highly significance difference of total analgesics
consumed in 24 h PO between the groups
v2
= 21.36 P 0.001 very highly significant
J. Maxillofac. Oral Surg.
123
6. In our study, the mean pain intensity scores as per
Verbal Response Scale (VRS) reported a significant pain
relief from 1st to 12th hours postoperatively and according
to Visual Analog Scale (VAS), showed a significant pain
relief from 3rd to 6th hours postoperatively. It was
according to Mario A et al. who noted statistically
Fig. 3 Graph 3 showing
complications in both the
groups
Fig. 4 Graph 4 showing
comparison of overall
assessment between the two
groups
J. Maxillofac. Oral Surg.
123
7. significant difference in pain intensity score (VAS) mea-
sured at 6 h post-surgery between studied groups [23].
The mean time to take first rescue analgesic for group A
was found statistically significant with 6.96 h with oral
ketorolac along with local tramadol and 4.59 h with oral
ketorolac along with local saline as placebo in group B
which was found significant clinically as pain after third
molar surgery was most severe between 6 and 8 h. This
was in contrast to the study by Mario A et al. who reported
the mean time to take first rescue analgesic was of
approximately 5.13 min for both the groups which was not
found statistically significant (P [ 0.05) [23].
We found that 3 patient in group A needed no pain
medication within 10 h after surgery as compared with all
40 patients from group B. This finding was according to the
study by Mario A et al. who reported that only 1 patient in
group A needed no analgesic within 12 h postoperatively
as compared with 10 patients in group B [23]. This sug-
gests that use of combination of analgesics (ketoro-
lac ? tramadol) as preemptive analgesics proved better
than use of single analgesic (ketorolac) and needs less
consumption of analgesics after surgery.
But in terms of postoperative complications associated
with the study drugs, nausea, headache and vomiting are
the major adverse effects of tramadol same as suggested by
previous studies [19]. In our study, after receiving sub-
mucous tramadol, 5 patients (12.5%) complained head-
ache, 8 patients (20%) complained nausea and 3 patients
(7.5%) reported vomiting out of which only 3 demanded
the rescue antiemetic in group A. Intraoperative complaints
like respiratory depression and perspiration on injection of
tramadol was not reported in any patient in our clinical trial
which was consistent according to previous studies [24].
Local reactions like itching and pain on injection, erythema
were also reported with tramadol administration in our
study. This was consistent as reported in a meta-analysis on
a paracetamol and tramadol combination. [25].
By adapting such analgesic combination and preemptive
study design, postoperative quality of the life of patients
improves which can be assessed by doing Global assess-
ment. Our study shows that patients of group A, on 32
occasions and patients of group B, on 9 occasions, graded
the overall patients satisfaction as good which was found to
be consistent with the previous studies [26, 27]. Few
studies advocated that submucosal tramadol injection dur-
ing surgical procedure has remarkable effect to reduce
postoperative pain and extension of anesthetic duration of
articaine [28, 29].
Conclusion
Our clinical trial suggests that preemptive use of oral
ketorolac along with local tramadol are better tolerated
than ketorolac and can be used as an alternative for the
treatment of acute pain following surgical removal of third
molars. The patients experienced significantly lower pain
intensity scores in the immediate postoperative phase with
oral ketorolac plus local tramadol. The results of this study
also reveal that the drugs are associated with minimal side
affects or local reactions in addition to the need for less
number of analgesics consumed in first 24 h postopera-
tively providing a good patient compliance. Hence, it can
be concluded that preemptive oral ketorolac with tramadol
in comparison with oral ketorolac results in better pain
relief, longer pain free intervals with minimum rescue
analgesics requirement lesser postoperative analgesics
consumption.
Funding Self funded.
Compliance with Ethical Standards
Conflict of interest None.
Ethical Approval Institutional ethical clearance taken.
Informed Consent Patient consents taken.
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