Current and emerging COX inhibitors for treating postoperative pain following oral surgery

ABSTRACT

Introduction

The numerous drugs in the NSAID class are often used to treat acute postoperative pain associated with oral surgery such as impacted third-molar extractions. These drugs are effective in this setting and dental pain studies often serve as models for acute pain relief and for registration of analgesics. With numerous cyclooxygenase (COX) inhibitors available as monotherapy, for use in combination with analgesic regimens, and in different doses and formulations, it was our aim to determine if there were clear-cut distinctions among these products and dosing regimens.

Areas Covered

This is a literature review of recent randomized controlled clinical trials evaluating NSAIDs for use in postoperative pain management following oral surgery. Of particular interest were head-to-head studies, which might offer some insight into comparative effectiveness.

Expert opinion

Postoperative oral surgery pain is largely managed in real-world clinical practice using NSAIDs, either alone or in combination, and there is good evidence supporting their use especially in multimodal therapy. Head-to-head and comparative studies do not show a clear-cut ‘optimal NSAID’ in this setting, although ibuprofen, ketoprofen, dexketoprofen, and naproxen have gained most acceptance. Combination therapy with other analgesics or adjuvants is largely accepted.

KEYWORDS:

• Acute postoperative pain
• dexketoprofen
• ibuprofen
• naproxen
• nonsteroidal anti-inflammatory drugs
• oral surgery pain
• postoperative oral surgery pain

Article highlights

• Ibuprofen 400 mg and diclofenac 50 mg are frequently used in real-world clinical practice to treat acute pain following oral surgery.

• Head-to-head studies of NSAIDs fail to show a vastly or clearly superior analgesic.

• Route of administration (oral, IV) and timing (pre- or postoperative) of dosing may play a role in effectiveness but studies are too few to draw conclusions.

• Corticosteroids such as dexamethasone may be an important adjuvant agent to manage inflammation and inflammatory pain following oral surgery but further study is needed to determine if this benefit might be offset by delays in wound healing.

• Fixed-dose combination products with an NSAID and a small amount of opioid can be safe and effective in this setting, such as dexketoprofen/tramadol or acetaminophen/codeine.

This box summarizes key points contained in the article.

Acknowledgments

The authors thank S Catoe for her assistance through proofreading the manuscript and for offering editorial comments.

Declaration of interest

J Pergolizzi and J LeQuang are both employees of NEMA Research. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.