Does Ketorolac reduce the intensity of postoperative pain after impacted third molars surgery in adults compared to the use of tramadol? A systematic review and meta-analysis

Authors

DOI:

https://doi.org/10.33448/rsd-v10i3.13137

Keywords:

Ketorolac; Tramadol; Molar, third; Surgery, Oral; Meta-analysis.

Abstract

This systematic review and meta-analysis evaluated if ketorolac reduces the intensity of postoperative pain after impacted third molars surgery in adults compared to the use of tramadol. A comprehensive search was performed in the MEDLINE/PubMed, Scopus, Web of Science, LILACS, BBO, EMBASE, Cochrane Library, SIGLE and grey literature, in accordance with the PRISMA guidelines. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. After duplicates removal, 4526 articles were identified, but only nine studies were included for qualitative analysis. After updating in 2021, four studies were added, totaling 13 studies included for qualitative analysis. Only two studies, classified at “low” risk of bias, were included in the meta-analysis of the primary outcome. The difference in means for pain intensity (moderate quality of evidence due to imprecision) was – 0.27 (95% CI = – 0.82 to 0.28; p = 0.34). Data from adverse effects (low quality of evidence due to very serious issues in imprecision) was just reported in one study at “low” risk of bias. Data was not heterogeneous (Chi2 test p = 0.14; I2 = 55%). It was not possible to evaluate any secondary outcomes (time to first rescue analgesic drug in h, total amount of analgesics consumed and adverse effects) due to low number of studies included. There is a lack of strong evidence to assure the superiority of ketorolac or tramadol in reducing the postoperative pain after extraction of impacted third molars.

References

Bailey, E., Worthington, H., & Coulthard, P. (2014). Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth, a Cochrane systematic review. Br Dent J, 216(8), 451-455. doi:10.1038/sj.bdj.2014.330

Barden, J., Edwards, J. E., McQuay, H. J., Wiffen, P. J., & Moore, R. A. (2004). Relative efficacy of oral analgesics after third molar extraction. Br Dent J, 197(7), 407-411; discussion 397. doi:10.1038/sj.bdj.4811721

Brown, C. R., Moodie, J. E., Dickie, G., Wild, V. M., Smith, B. A., Clarke, P. J., . . . Bynum, L. J. (1990). Analgesic efficacy and safety of single-dose oral and intramuscular ketorolac tromethamine for postoperative pain. Pharmacotherapy, 10(6 ( Pt 2)), 59s-70s.

Buckley, M. M., & Brogden, R. N. (1990). Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential. Drugs, 39(1), 86-109. doi:10.2165/00003495-199039010-00008

Catapano, M. S. (1996). The analgesic efficacy of ketorolac for acute pain. J Emerg Med, 14(1), 67-75. doi:10.1016/0736-4679(95)02052-7

Chethan, R., Ramamuthy, T. K., Patil, S., & Reddy, S. (2015). Comparative study of analgesic effectiveness of tramadol and ketorolac in the pain management of surgical removal of third molar: a randomized double blinded study. Journal of Research in Dentistry, 3(4), 775-780.

Christensen, K., Daniels, S., Bandy, D., Ernst, C. C., Hamilton, D. A., Mermelstein, F. H., . . . Carr, D. B. J. A. p. (2011). A double-blind placebo-controlled comparison of a novel formulation of intravenous diclofenac and ketorolac for postoperative third molar extraction pain. 58(2), 73-81.

Daniels, S., Reader, S., Berry, P., & Goulder, M. (2009). Onset of analgesia with sodium ibuprofen, ibuprofen acid incorporating poloxamer and acetaminophen--a single-dose, double-blind, placebo-controlled study in patients with post-operative dental pain. Eur J Clin Pharmacol, 65(4), 343-353. doi:10.1007/s00228-009-0614-y

Dayashankara Rao, J. K., Suma, G. N., Lal, A. B., Batra, R. S., Gehlot, N., & Nadini, G. D. (2010). Comparative study of opioid and non opioid analgesics in post operative pain control. . Journal of Oral Sign, 2(1), 4-12.

Dray, A. (1997). Kinins and their receptors in hyperalgesia. Can J Physiol Pharmacol, 75(6), 704-712.

Eggers, K. A., & Power, I. (1995). Tramadol. Br J Anaesth, 74(3), 247-249. doi:10.1093/bja/74.3.247

Eroglu, C. N., Ataoglu, H., Yildirim, G., & Kiresi, D. (2015). Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar. Med Oral Patol Oral Cir Bucal, 20(5), e627-632. doi:10.4317/medoral.20582

Esteller-Martínez, V., Paredes-García, J., Valmaseda-Castellón, E., Berini-Aytés, L., & Gay-Escoda, C. (2004). Analgesic efficacy of diclofenac sodium versus ibuprofen following surgical extraction of impacted lower third molars. Med Oral Patol Oral Cir Bucal, 9(5), 448-453; 444-448.

Flores-Murrieta, F. J., & Granados-Soto, V. J. C. D. R. (1996). Pharmacologic properties of ketorolac tromethamine: a potent analgesic drug. 2(1), 75-90.

Forbes, J. A., Butterworth, G. A., Burchfield, W. H., & Beaver, W. T. (1990). Evaluation of ketorolac, aspirin, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy, 10, 6 ( Pt 2), 77s-93s.

Forbes, J. A., Kehm, C. J., Grodin, C. D., & Beaver, W. T. (1990). Evaluation of ketorolac, ibuprofen, acetaminophen, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy, 10,6 ( Pt 2), 94s-105s.

Fricke, J. R., Jr., Angelocci, D., Fox, K., McHugh, D., Bynum, L., & Yee, J. P. (1992). Comparison of the efficacy and safety of ketorolac and meperidine in the relief of dental pain. J Clin Pharmacol, 32(4), 376-384. doi:10.1002/j.1552-4604.1992.tb03850.x

Gaynes, B. I., & Barkin, R. L. (1999). Analgesics in ophthalmic practice: a review of the oral non-narcotic agent tramadol. Optom Vis Sci, 76(7), 455-461. doi:10.1097/00006324-199907000-00020

Gopalraju, P., Lalitha, R. M., Prasad, K., & Ranganath, K. (2014). Comparative study of intravenous Tramadol versus Ketorolac for preventing postoperative pain after third molar surgery--a prospective randomized study. J Craniomaxillofac Surg, 42(5), 629-633. doi:10.1016/j.jcms.2013.09.004

Guyatt, G. H., Oxman, A. D., Schünemann, H. J., Tugwell, P., & Knottnerus, A. (2011). GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol, 64(4), 380-382. doi:10.1016/j.jclinepi.2010.09.011

Happonen, R. P., Oksala, E., & Ylipaavalniemi, P. (1987). A combination of acetylsalicylic acid and codeine phosphate versus acetylsalicylic acid as postoperative analgesics after mandibular third molar surgery. Proc Finn Dent Soc, 83(1), 32-35.

Higgins, J. P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2019). Cochrane handbook for systematic reviews of interventions: John Wiley & Sons.

Isiordia-Espinoza, M. A., de Jesús Pozos-Guillén, A., & Aragon-Martinez, O. H. (2014). Analgesic efficacy and safety of single-dose tramadol and non-steroidal anti-inflammatory drugs in operations on the third molars: a systematic review and meta-analysis. Br J Oral Maxillofac Surg, 52(9), 775-783. doi:10.1016/j.bjoms.2014.05.005

Isiordia-Espinoza, M. A., Pozos-Guillen, A., Martinez-Rider, R., & Perez-Urizar, J. (2016). Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial. Med Oral Patol Oral Cir Bucal, 21(5), e637-643. doi:10.4317/medoral.21077

Isiordia-Espinoza, M. A., Pozos-Guillén, A. J., Martínez-Rider, R., Herrera-Abarca, J. E., & Pérez-Urizar, J. (2011). Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery. Med Oral Patol Oral Cir Bucal, 16(6), e776-780. doi:10.4317/medoral.16854

Isiordia-Espinoza, M. A., Sánchez-Prieto, M., Tobías-Azúa, F., & Reyes-García, J. G. (2012). Pre-emptive analgesic effectiveness of meloxicam versus tramadol after mandibular third molar surgery: a pilot study. J Oral Maxillofac Surg, 70(1), 31-36. doi:10.1016/j.joms.2011.03.039

Jung, D., Mroszczak, E., & Bynum, L. (1988). Pharmacokinetics of ketorolac tromethamine in humans after intravenous, intramuscular and oral administration. Eur J Clin Pharmacol, 35(4), 423-425. doi:10.1007/bf00561376

Jung, D., Mroszczak, E. J., Wu, A., Ling, T. L., Sevelius, H., & Bynum, L. (1989). Pharmacokinetics of ketorolac and p-hydroxyketorolac following oral and intramuscular administration of ketorolac tromethamine. Pharm Res, 6(1), 62-65. doi:10.1023/a:1015803803650

Laureano Filho, J. R., Maurette, P. E., Allais, M., Cotinho, M., & Fernandes, C. (2008). Clinical comparative study of the effectiveness of two dosages of Dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med Oral Patol Oral Cir Bucal, 13(2), E129-132.

Le Roux, P. J., & Coetzee, J. F. (2000). Tramadol today. Curr Opin Anaesthesiol, 13(4), 457-461. doi:10.1097/00001503-200008000-00010

Lintz, W., Beier, H., & Gerloff, J. (1999). Bioavailability of tramadol after i.m. injection in comparison to i.v. infusion. Int J Clin Pharmacol Ther, 37(4), 175-183.

Loeser, J. D., & Melzack, R. (1999). Pain: an overview. Lancet, 353(9164), 1607-1609. doi:10.1016/s0140-6736(99)01311-2

López Carriches, C., Martínez González, J. M., & Donado Rodríguez, M. (2006). The use of methylprednisolone versus diclofenac in the treatment of inflammation and trismus after surgical removal of lower third molars. Med Oral Patol Oral Cir Bucal, 11(5), E440-445.

Mangalgi, A., Shah, K., Sajjanshetty, S., Patil, S., & Halkai, S. J. I. J. o. S. R. (2018). Intramuscular administration of ketorolac versus tramadol post operatively in minor oral surgery. 7(12).

Mansuri, S., Mujeeb, A., Hussain, S. A., & Hussain, M. A. (2014). Mandibular third molar impactions in male adults: Relationship of Operative time and Types of impaction on inflammatory complications. J Int Oral Health, 6(2), 9-15.

Mishra, H., & Khan, F. A. (2012). A double-blind, placebo-controlled randomized comparison of pre and postoperative administration of ketorolac and tramadol for dental extraction pain. J Anaesthesiol Clin Pharmacol, 28(2), 221-225. doi:10.4103/0970-9185.94892

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7), e1000097. doi:10.1371/journal.pmed.1000097

Moraschini, V., Hidalgo, R., & Porto Barboza, E. (2016). Effect of submucosal injection of dexamethasone after third molar surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg, 45(2), 232-240. doi:10.1016/j.ijom.2015.09.008

Nasyam, F. A. J. I. J. o. P. I. (2020). A Double-blind, Placebo-controlled, Randomized Comparison of Analgesic Efficacy of Oral Ketorolac Versus Intramuscular Tramadol After Third Molar Surgery. 10(4), 586-589.

Noronha, V. R., Gurgel, G. D., Alves, L. C., Noman-Ferreira, L. C., Mendonça, L. L., Aguiar, E. G., & Abdo, E. N. (2009). Analgesic efficacy of lysine clonixinate, paracetamol and dipyrone in lower third molar extraction: a randomized controlled trial. Med Oral Patol Oral Cir Bucal, 14(8), e411-415.

Olmedo, M. V., Gálvez, R., & Vallecillo, M. (2001). Double-blind parallel comparison of multiple doses of ketorolac, ketoprofen and placebo administered orally to patients with postoperative dental pain. Pain, 90(1-2), 135-141. doi:10.1016/s0304-3959(00)00396-1

Ong, C. K., & Seymour, R. A. (2003). Pathogenesis of postoperative oral surgical pain. Anesth Prog, 50(1), 5-17.

Ong, K. S., & Tan, J. M. (2004). Preoperative intravenous tramadol versus ketorolac for preventing postoperative pain after third molar surgery. Int J Oral Maxillofac Surg, 33(3), 274-278. doi:10.1006/ijom.2003.0515

Passi, D., Singh, M., Sing, A., Dutta, S., Goyal, J., Yadav, G., . . . Srivastava, D. (2018). Comparative Evaluation of Analgesic Efficacy of Oral Ketorolac and Tramadol after Impacted Mandibular Third Molar Surgery: A Short Clinical Study with Literature Review. Annals of Medical and Health Sciences Research., 8, 157-162.

Pathi, J., Vidya, K., & Sangamesh, N. J. N. J. o. M. S. (2020). Tramadol versus ketorolac for pain management after third molar surgery. 11(2), 236.

Schulz, K. F., Chalmers, I., Hayes, R. J., & Altman, D. G. (1995). Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. Jama, 273(5), 408-412. doi:10.1001/jama.273.5.408

Schünemann, H. J., Oxman, A. D., Higgins, J. P., Vist, G. E., Glasziou, P., & Guyatt, G. H. J. C. h. f. s. r. o. i. (2008). Presenting results and ‘Summary of findings’ tables. 5, 0.

Scott, L. J., & Perry, C. M. (2000). Tramadol: a review of its use in perioperative pain. Drugs, 60(1), 139-176. doi:10.2165/00003495-200060010-00008

Seymour, R. A., Meechan, J. G., & Blair, G. S. (1985). An investigation into post-operative pain after third molar surgery under local analgesia. Br J Oral Maxillofac Surg, 23(6), 410-418. doi:10.1016/0266-4356(85)90025-7

Shah, A. V., Arun Kumar, K. V., Rai, K. K., & Rajesh Kumar, B. P. (2013). Comparative evaluation of pre-emptive analgesic efficacy of intramuscular ketorolac versus tramadol following third molar surgery. J Maxillofac Oral Surg, 12(2), 197-202. doi:10.1007/s12663-012-0420-4

Shaik, M., Kumar, J., Mobina, S., Satyanarayana, N., & Sunitha, P. J. J. o. C. o. M. S.-N. (2010). Comparative study of tramadol and ketorolac in the pain management of third molar tooth extraction. 6(1), 35-43.

Shaik, M. M., Kumar, J., Mobina, S., Satyanarayana, N., & Sunitha, P. (2010). Comparative study of tramadol and ketorolac in the pain management of third molar tooth extraction. Journal of College of Medical Sciences-Nepal 6(1), 35-43.

Shankariah, M., Mishra, M., & Kamath, R. A. (2012). Tramadol versus ketorolac in the treatment of postoperative pain following maxillofacial surgery. J Maxillofac Oral Surg, 11(3), 264-270. doi:10.1007/s12663-011-0321-y

Singh, P., Rastogi, S., Bansal, M., Kumar, S., Singh, R., Nishad, S. G., . . . Thayath, M. N. (2015). A prospective study to assess the levels of interleukin-6 following administration of diclofenac, ketorolac and tramadol after surgical removal of lower third molars. J Maxillofac Oral Surg, 14(2), 219-225. doi:10.1007/s12663-013-0609-1

Tenglikar, P. D. (2014). Analgesic efficacy of tramadol and ketrolac following third molar surgery. International Journal of Dental Clinics. , 6(4), 8-10.

Tenglikar, P. D. J. I. J. o. D. C. (2014). Analgesic efficacy of tramadol and ketrolac following third molar surgery. 6(4).

Vadivelu, N., Gowda, A. M., Urman, R. D., Jolly, S., Kodumudi, V., Maria, M., . . . Pergolizzi, J. V., Jr. (2015). Ketorolac tromethamine - routes and clinical implications. Pain Pract, 15(2), 175-193. doi:10.1111/papr.12198

Zackova, M., Taddei, S., Calò, P., Bellocchio, A., & Zanello, M. (2001). Ketorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery. Minerva Anestesiol, 67(9), 641-646.

Downloads

Published

12/03/2021

How to Cite

MARTINS, L. D.; REZENDE, M.; CHIBINSKI, A. C.; LOGUERCIO, A. D.; BORTOLUZZI, M. C. .; ARAÚJO, J.; REIS, A. Does Ketorolac reduce the intensity of postoperative pain after impacted third molars surgery in adults compared to the use of tramadol? A systematic review and meta-analysis. Research, Society and Development, [S. l.], v. 10, n. 3, p. e19410313137, 2021. DOI: 10.33448/rsd-v10i3.13137. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/13137. Acesso em: 14 apr. 2021.

Issue

Section

Health Sciences