Etoricoxib may be answer to wisdom tooth surgery pain

By Melissa Busch, DrBicuspid.com associate editor

September 27, 2021 -- A preemptive low dose of the nonsteroidal anti-inflammatory drug (NSAID) etoricoxib may reduce the need for analgesics after third-molar surgery, based on the results of a randomized clinical trial published on September 23 in BMC Oral Health.

Patients who were given etoricoxib 30 minutes before surgery were less likely to take analgesic medication during the 24-hour period following the procedure, the authors wrote.

"Etoricoxib has a substantial pre-emptive analgesic effect, resulting in the reduced use of analgesics after third molar removal," wrote the group, led by Dr. Long Xie of Wuhan University and Dr. Lei Sang of Suzhou Vocational Health College, both in China.

Etoricoxib is a selective inhibitor of the cyclooxygenase-2 (COX-2) enzyme. The NSAID has been shown to be an effective analgesic with a decreased risk of bleeding in patients who have ulcers and platelet dysfunction.

Currently, it is approved for use in 80 countries, including the U.K., Italy, Spain, and New Zealand. In 2007, the U.S. Food and Drug Administration (FDA) voted against approving etoricoxib for arthritis pain due to cardiovascular risks.

From August 2019 to July 2020, 56 patients participated in the randomized, parallel, double-blind, placebo-controlled clinical trial of etoricoxib. The participants were healthy and were scheduled to undergo surgical removal of impacted horizontal mandibular third molars.

To study the medication's effect on pain, 28 patients were given 60 mg of etoricoxib 30 minutes prior to surgery, and the remaining 28 participants were given a placebo, the authors wrote.

Of those who received etoricoxib, only eight took analgesics during the 24-hour evaluation period after surgery, compared with 21 patients in the placebo group.

Effect of etoricoxib on patient analgesic use after 3rd-molar surgery
Analgesic use Patients receiving placebo Patients receiving etoricoxib
Took analgesics 21 (75%) 8 (29%)
Did not take analgesics 7 (25%) 20 (71%)

Limitations of the study included the fact that a pain assessment was not conducted 24 hours after the procedure, the authors noted.

Though more research is needed, etoricoxib shows promise as a pain reliever for third-molar surgery, according to the authors.

"This study revealed that a low dose of etoricoxib has pre-emptive analgesic effect, resulting in the reduced use of analgesics after third molar removal," they concluded.


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