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Erschienen in: Journal of Maxillofacial and Oral Surgery 3/2022

27.04.2022 | Original Article

Analgesia and Side Effects of Codeine Phosphate Associated with Paracetamol Versus Oxycodone After the Extraction of Mandibular Third Molars: A Randomized Double-Blind Clinical Trial Using the Split-Mouth Model

verfasst von: Matheus Furtado de Carvalho, Gabriela de Matos Silveira, Paula Afonso Rodrigues de Carvalho, Isabel Cristina Gonçalves Leite, Maria da Graça Naclério-Homem

Erschienen in: Journal of Maxillofacial and Oral Surgery | Ausgabe 3/2022

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Abstract

Purpose

To assess the analgesia and side effects of 10 mg oxycodone as compared to 30 mg of codeine phosphate associated with 500 mg of paracetamol after bilateral lower third molar extraction.

Methods

This is a prospective, randomized, double-blind study applied to a sample of 16 patients. They were evaluated for seven days postoperatively, and the mean score of the visual analogue scale (VAS) of pain between test and control medications was assessed by the Wilcoxon distribution. The side effects of these medications were assessed by the Q Cochran test. A p value of < .05 was considered statistically significant.

Results

The mean score of the VAS of pain was higher in the oxycodone side, where few patients reported the use of rescue analgesic. There was no report of rescue medication in codeine phosphate associated with paracetamol side. The most common side effects reported in both groups, predominantly in patients using the oxycodone, were drowsiness, dizziness, and headache.

Conclusion

The use of codeine phosphate associated with paracetamol after the extraction of impacted mandibular third molars is a better choice than oxycodone for controlling postoperative pain.

Trial Registration Number and Date of Registration

RBR-8ntwmyq 07/07/2021.
Literatur
1.
Zurück zum Zitat Sirin Y, Humphris G, Sencan S, Firat D (2012) What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic. Int J Oral Maxillofac Surg 41:1284–1290CrossRef Sirin Y, Humphris G, Sencan S, Firat D (2012) What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic. Int J Oral Maxillofac Surg 41:1284–1290CrossRef
2.
Zurück zum Zitat International Association for Study of Pain. IASP Taxonomy (2020) Cited 2021 May 25 International Association for Study of Pain. IASP Taxonomy (2020) Cited 2021 May 25
3.
Zurück zum Zitat Litkowski JL, Chistensen ES, Adamson DN, Van Dyke T, Han SH, Newman KB (2005) Analgesic efficacy and tolerability of oxycodone 5 mg/ ibuprofen 400 mg compared with those of oxycodone 5 mg/ acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain: a randomized, double-blind, placebo-controlled, single-dose, parallel-group study in a dental pain model. Clin Ther 27:418–429CrossRef Litkowski JL, Chistensen ES, Adamson DN, Van Dyke T, Han SH, Newman KB (2005) Analgesic efficacy and tolerability of oxycodone 5 mg/ ibuprofen 400 mg compared with those of oxycodone 5 mg/ acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain: a randomized, double-blind, placebo-controlled, single-dose, parallel-group study in a dental pain model. Clin Ther 27:418–429CrossRef
4.
Zurück zum Zitat Macleod AG, Ashford B, Voltz M, Williams B, Cramond T, Gorta L et al (2002) Paracetamol versus paracetamol-codeine in the treatment of post-operative dental pain: a randomized, double-blind, prospective trial. Aust Dent J 47:147–151CrossRef Macleod AG, Ashford B, Voltz M, Williams B, Cramond T, Gorta L et al (2002) Paracetamol versus paracetamol-codeine in the treatment of post-operative dental pain: a randomized, double-blind, prospective trial. Aust Dent J 47:147–151CrossRef
5.
Zurück zum Zitat Carvalho MF, Silva YS, Reher P, Naclério-Homem MG (2021) Analgesia and side effects of codeine phosphate associated with paracetamol vs. paracetamol after the extraction of mandibular third molars: a randomized double-blind clinical trial using the split-mouth model. Oral Maxillofac Surg 25:49–53CrossRef Carvalho MF, Silva YS, Reher P, Naclério-Homem MG (2021) Analgesia and side effects of codeine phosphate associated with paracetamol vs. paracetamol after the extraction of mandibular third molars: a randomized double-blind clinical trial using the split-mouth model. Oral Maxillofac Surg 25:49–53CrossRef
6.
Zurück zum Zitat Rosero EB, Joshi GP (2014) Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg 134:85S-93SCrossRef Rosero EB, Joshi GP (2014) Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg 134:85S-93SCrossRef
7.
Zurück zum Zitat Mattia C, Coluzzi F (2015) A look inside the association codeine-paracetamol: clinical pharmacology supports analgesic efficacy. Eur Ver Med Pharmacol Sci 19:507–516 Mattia C, Coluzzi F (2015) A look inside the association codeine-paracetamol: clinical pharmacology supports analgesic efficacy. Eur Ver Med Pharmacol Sci 19:507–516
8.
Zurück zum Zitat Resnick CM, Calabrese CE, Afshar S, Padwa BL (2019) Do oral and maxillofacial surgeons over-prescribe opioids after extraction of asymptomatic third molars? J Oral Maxillofac Surg 77:1332–1336CrossRef Resnick CM, Calabrese CE, Afshar S, Padwa BL (2019) Do oral and maxillofacial surgeons over-prescribe opioids after extraction of asymptomatic third molars? J Oral Maxillofac Surg 77:1332–1336CrossRef
9.
Zurück zum Zitat Winter GB (1926) Principles of exodontia as applied to the impacted third molars: a complete treatise on the which clinical diagnosis and radiographics interpretation. St Louis. American Medical Book Company Winter GB (1926) Principles of exodontia as applied to the impacted third molars: a complete treatise on the which clinical diagnosis and radiographics interpretation. St Louis. American Medical Book Company
10.
Zurück zum Zitat Pell GJ, Gregory GT (1933) Impacted third molars: classification and modified technique for removal. Dent Digest 39:330–338 Pell GJ, Gregory GT (1933) Impacted third molars: classification and modified technique for removal. Dent Digest 39:330–338
11.
Zurück zum Zitat Pozos AJ, Martinez R, Aguirre P, Perez J (2006) The effects of tramadol added to articaine on anesthesia duration. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology 102:614–617CrossRef Pozos AJ, Martinez R, Aguirre P, Perez J (2006) The effects of tramadol added to articaine on anesthesia duration. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology 102:614–617CrossRef
12.
Zurück zum Zitat Jerjes W, Upile T, Nhembe F, Gudka D, Shah P, Abbas S, McCarthy E, Patel S, Mahil J, Hopper C (2010) Experience in third molar surgery: an update. Br Dent J 209(1):E1CrossRef Jerjes W, Upile T, Nhembe F, Gudka D, Shah P, Abbas S, McCarthy E, Patel S, Mahil J, Hopper C (2010) Experience in third molar surgery: an update. Br Dent J 209(1):E1CrossRef
13.
Zurück zum Zitat Seymour RA, Blair GS, Wyatt FAR (1983) Post-operative dental pain and analgesic efficacy. J Oral Surg 21:290–297CrossRef Seymour RA, Blair GS, Wyatt FAR (1983) Post-operative dental pain and analgesic efficacy. J Oral Surg 21:290–297CrossRef
14.
Zurück zum Zitat Contar CM, de Oliveira P, Kanegusuku K, Berticelli RD, Azevedo Alanis LR, Machado MA (2010) Complications in third molar removal:a retrospective study of 588 patients. Med Oral Patol Oral Cir Bucal 15:74–78 Contar CM, de Oliveira P, Kanegusuku K, Berticelli RD, Azevedo Alanis LR, Machado MA (2010) Complications in third molar removal:a retrospective study of 588 patients. Med Oral Patol Oral Cir Bucal 15:74–78
15.
Zurück zum Zitat Su N, Liu Y, Yang X, Shi Z, Huang Y (2014) Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials. Int Dent J 64:96–107CrossRef Su N, Liu Y, Yang X, Shi Z, Huang Y (2014) Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials. Int Dent J 64:96–107CrossRef
16.
Zurück zum Zitat Hass DA (2002) An update on local anesthetics in dentistry. J Can Dent Assoc 68:546–551 Hass DA (2002) An update on local anesthetics in dentistry. J Can Dent Assoc 68:546–551
17.
Zurück zum Zitat Rodrigues ÉD, Pereira GS, Vasconcelos BC, Ribeiro RC (2019) Effect of preemptive dexamethasone and etoricoxib on postoperative period following impacted third molar surgery - a randomized clinical trial. Med Oral Patol Oral Cir Bucal 24:e746–e751PubMedPubMedCentral Rodrigues ÉD, Pereira GS, Vasconcelos BC, Ribeiro RC (2019) Effect of preemptive dexamethasone and etoricoxib on postoperative period following impacted third molar surgery - a randomized clinical trial. Med Oral Patol Oral Cir Bucal 24:e746–e751PubMedPubMedCentral
18.
Zurück zum Zitat Lima TC, Bagordakis E, Falci SGM, Dos Santos CRR, Pinheiro MLP (2018) Pre-emptive effect of dexamethasone and diclofenac sodium associated with codeine on pain, swelling, and trismus after third molar surgery: a split-mouth, randomized, triple-blind, controlled clinical trial. J Oral Maxillofac Surg 76:60–66CrossRef Lima TC, Bagordakis E, Falci SGM, Dos Santos CRR, Pinheiro MLP (2018) Pre-emptive effect of dexamethasone and diclofenac sodium associated with codeine on pain, swelling, and trismus after third molar surgery: a split-mouth, randomized, triple-blind, controlled clinical trial. J Oral Maxillofac Surg 76:60–66CrossRef
19.
Zurück zum Zitat Vicentini CB, Ramacciato JC, Groppo FC, Teixeira RG, Motta RHL (2018) Clinical evaluation of two dexamethasone regimens in the extractions of impacted third molars-a randomized clinical trial. Oral Maxillofac Surg 22:177–183CrossRef Vicentini CB, Ramacciato JC, Groppo FC, Teixeira RG, Motta RHL (2018) Clinical evaluation of two dexamethasone regimens in the extractions of impacted third molars-a randomized clinical trial. Oral Maxillofac Surg 22:177–183CrossRef
20.
Zurück zum Zitat Alcântara CE, Falci SG, Oliveira-Ferreira F, Santos CR, Pinheiro ML (2014) Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg 43:93–98CrossRef Alcântara CE, Falci SG, Oliveira-Ferreira F, Santos CR, Pinheiro ML (2014) Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg 43:93–98CrossRef
21.
Zurück zum Zitat Snyder M, Shugars DA, White RP, Phillips C (2005) Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery. J Oral Maxillofac Surg 63:1130–1137CrossRef Snyder M, Shugars DA, White RP, Phillips C (2005) Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery. J Oral Maxillofac Surg 63:1130–1137CrossRef
22.
Zurück zum Zitat Jung YS, Kim DK, Kim MK, Kim HJ, Cha IH, Lee EW (2004) Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/ acetaminophen/ ibuprofen in acute postoperative pain: a single-center, single-dose, randomized, active-controlled, parallel-group study in a dental surgery pain model. Clin Ther 26:1037–1045CrossRef Jung YS, Kim DK, Kim MK, Kim HJ, Cha IH, Lee EW (2004) Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/ acetaminophen/ ibuprofen in acute postoperative pain: a single-center, single-dose, randomized, active-controlled, parallel-group study in a dental surgery pain model. Clin Ther 26:1037–1045CrossRef
23.
Zurück zum Zitat Chang DJ, Bird SR, Bohidar NR, King T (2005) Analgesic efficacy of rofecoxib compared with codeine/acetaminophen using a model of acute dental pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:74–80CrossRef Chang DJ, Bird SR, Bohidar NR, King T (2005) Analgesic efficacy of rofecoxib compared with codeine/acetaminophen using a model of acute dental pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:74–80CrossRef
24.
Zurück zum Zitat Daniels SE, Bandy DP, Christensen SE, Boice J, Losada MC, Liu H, Mehta A, Peloso PM (2011) Evaluation of the dose range of etoricoxib in an acute pain setting using the postoperative dental pain model. Clin J Pain 27:1–8CrossRef Daniels SE, Bandy DP, Christensen SE, Boice J, Losada MC, Liu H, Mehta A, Peloso PM (2011) Evaluation of the dose range of etoricoxib in an acute pain setting using the postoperative dental pain model. Clin J Pain 27:1–8CrossRef
25.
Zurück zum Zitat Gatoulis SC, Voelker M, Fisher M (2012) Assessment of the efficacy and safety profiles of aspirin and acetaminophen with codeine: results from 2 randomized, controlled trials in individuals with tension-type headache and postoperative dental pain. Clin Ther 34:138–148CrossRef Gatoulis SC, Voelker M, Fisher M (2012) Assessment of the efficacy and safety profiles of aspirin and acetaminophen with codeine: results from 2 randomized, controlled trials in individuals with tension-type headache and postoperative dental pain. Clin Ther 34:138–148CrossRef
26.
Zurück zum Zitat Mutlu I, Abubaker AO, Laskin DM (2013) Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg 71:1500–1503CrossRef Mutlu I, Abubaker AO, Laskin DM (2013) Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg 71:1500–1503CrossRef
27.
Zurück zum Zitat WHO (1996) Cancer pain relief: with a guide to opioid availability. World Health Organization, Geneva WHO (1996) Cancer pain relief: with a guide to opioid availability. World Health Organization, Geneva
28.
Zurück zum Zitat Best AD, De Silva RK, Thomson WM, Tong DC, Cameron CM, De Silva HL (2017) Efficacy of codeine when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: a double-blinded randomized control trial. J Oral Maxillofac Surg 75:2063–2069CrossRef Best AD, De Silva RK, Thomson WM, Tong DC, Cameron CM, De Silva HL (2017) Efficacy of codeine when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: a double-blinded randomized control trial. J Oral Maxillofac Surg 75:2063–2069CrossRef
29.
Zurück zum Zitat Gay-Escoda C, Hanna M, Montero A, Dietrich T, Milleri S, Giergiel E, Zoltán TB, Varrassi G (2019) Tramadol/dexketoprofen (TRAM/DKP) compared with tramadol/paracetamol in moderate to severe acute pain: results of a randomised, double-blind, placebo and active-controlled, parallel group trial in the impacted third molar extraction pain model (DAVID study). BMJ Open 9:e023715CrossRef Gay-Escoda C, Hanna M, Montero A, Dietrich T, Milleri S, Giergiel E, Zoltán TB, Varrassi G (2019) Tramadol/dexketoprofen (TRAM/DKP) compared with tramadol/paracetamol in moderate to severe acute pain: results of a randomised, double-blind, placebo and active-controlled, parallel group trial in the impacted third molar extraction pain model (DAVID study). BMJ Open 9:e023715CrossRef
30.
Zurück zum Zitat Han JT, Susarla SM, Dodson TB, Lang MS (2020) Are oral and maxillofacial surgeons prescribing fewer opioids and more non-narcotic analgesics for postoperative pain after third molar removal? J Oral Maxillofac Surg 78:358–365CrossRef Han JT, Susarla SM, Dodson TB, Lang MS (2020) Are oral and maxillofacial surgeons prescribing fewer opioids and more non-narcotic analgesics for postoperative pain after third molar removal? J Oral Maxillofac Surg 78:358–365CrossRef
Metadaten
Titel
Analgesia and Side Effects of Codeine Phosphate Associated with Paracetamol Versus Oxycodone After the Extraction of Mandibular Third Molars: A Randomized Double-Blind Clinical Trial Using the Split-Mouth Model
verfasst von
Matheus Furtado de Carvalho
Gabriela de Matos Silveira
Paula Afonso Rodrigues de Carvalho
Isabel Cristina Gonçalves Leite
Maria da Graça Naclério-Homem
Publikationsdatum
27.04.2022
Verlag
Springer India
Erschienen in
Journal of Maxillofacial and Oral Surgery / Ausgabe 3/2022
Print ISSN: 0972-8279
Elektronische ISSN: 0974-942X
DOI
https://doi.org/10.1007/s12663-022-01717-2

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