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COMPARISON OF EFFICACY AND TOLERANCE OF PARACETAMOL/TRAMADOL WITH PARACETAMOL/CODEINE IN MANDIBULAR THIRD MOLAR SURGERY

Dr. M. Asim Naqash, Dr.Gulraiz Zulfiqar, Dr.Fatima tuz Zahra,Dr. Fahad Ahmad, Dr. Syed Shumail Ahmad

Mandibular third molar is the most frequently impacted tooth (prevalence 16.7% to 68.6%) [1] and is commonly removed by surgery. The surgical intervention is associated with moderate to severe postoperative pain, swelling and trismus. [2,3] Pain is generated by release of inflammatory endogenous chemical mediators such as bradykinin and prostaglandin. [4] Different anti-inflammatory and antibacterial drugs and insertion of cones or drains saturated with analgesic and antibiotic agents have been used by oral and maxillofacial surgeons for pain control. [5] Drugs of different classes with different mode of actions may also be combined to optimize their analgesic efficacy and tolerability. [6] The efficacy of paracetamol-codeine (PC) combination has proven a superior pain control over paracetamol alone but with associated complications of codeine like sedation, dizziness, nausea, vomiting and constipation. [7] Paracetamol has also been combined with tramadol (PT), an atypical weak opioid with a dual mechanism of action inclusive of a μ-opioid receptor activation and an enhancement of serotonin and norepinephrine transmission, for moderate to severe pain. [8] A significantly lower incidence of constipation, vomiting and other side effects have been reported with PT combination as compared to PC combination. [9] PT combination has not been widely reported for use in oral surgery. our study has several limitations. As one may argue that there is no control group receiving placebo, considering the surgical procedure being invasive one, placebo control group was not even possible. Also in our study, pain was evaluated after 24 hours post op and was not evaluated at different time points, with which more accurate results could have been achieved.

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