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Doctoral Thesis
DOI
10.11606/T.23.2010.tde-30082010-150907
Document
Author
Full name
Marcelo Minharro Ceccheti
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2010
Supervisor
Committee
Homem, Maria da Graca Naclerio (President)
Altruda Filho, Luiz
Deboni, Maria Cristina Zindel
Prokopowitsch, Igor
Tanji, Edgar Yuji
Title in Portuguese
Eficácia analgésica pós-operatória e ação anestésica adjuvante do cloridrato de tramadol utilizado localmente após exodontias de terceiros molares inferiores impactados
Keywords in Portuguese
Analgesia
Anestesia Cirurgia bucal
Dor pós-operatória
Terceiro molar
Tramadol
Abstract in Portuguese
Foi estudado o efeito analgésico e anestésico adjuvante do cloridrato de tramadol aplicado localmente, após extração do terceiro molar inferior impactado. Um total de 52 pacientes foi submetido à exodontia sob anestesia local (mepivacaína 2% 1:20 000 corbadrina), em estudo duplo-cego, dose única, cruzado, controlado por placebo. Pacientes e os lados dos procedimentos foram distribuídos aleatoriamente para receberem 2 ml de tramadol (100%) (grupo T) ou 2 ml de solução salina 0,9% (grupo P). Ambas as soluções foram injetadas na submucosa gengival e alvéolo, imediatamente após as cirurgias realizadas por um mesmo cirurgião. Impacção dental e quantidade anestésica foram pareadas. Dados do consumo e a hora de uso de analgésico de resgate (dipirona 500 mg) foram utilizados para avaliar o efeito analgésico de tramadol. Uma Escala Analógica Visual (EAV) de dor foi aplicada após término da anestesia, 4, 8, 24, 48 e 72 horas após cirurgia, com os dados submetidos ao teste de Wilcoxon (p < 0,05). Não houve diferença no bloqueio anestésico e efeitos adversos entre os grupos. O grupo T requisitou um número significativamente menor (p = 0,008) de comprimidos de dipirona durante o período de avaliação (3,37 ± 4,65) do que o grupo P (4,4 ± 3,71). O grupo T levou mais minutos para usar a dipirona após a primeira cirurgia (303,72 ± 416,01) do que o grupo P (185,4 ± 59,4) (p = 0,006). O grupo T apresentou menor média de dor na EAV após término da anestesia (3,55 ± 2,27) do que no grupo P (5,26 ± 2,49) (p = 0,001). O tramadol administrado localmente após exodontia de terceiros molares inferiores melhora a qualidade da analgesia pós-operatória, porém não prolonga a duração da anestesia local com mepivacaína.
Title in English
Efficacy of postoperative analgesia and adjuvant anesthetic action of local tramadol hydrochloride injection after impacted third molar extraction
Keywords in English
Analgesia
Anesthesia
Oral surgery
Postsurgical pain
Third molar
Tramadol
Abstract in English
The present study sought to assess the analgesic and adjuvant anesthetic effects of surgical site administration of tramadol hydrochloride immediately after extraction of impacted mandibular third molars. In this double-blind, placebo-controlled, singledose, crossover investigation, 52 patients underwent bilateral extraction of impacted mandibular third molars under local anesthesia (mepivacaine 2% with levonordefrin 1:20 000). Patients and procedures, by side of intervention, were randomly assigned to receive either 2 mL of tramadol (100%) (Group T, n = 52) or 2 mL of normal saline, 0.9% (Group P, n = 52). Medications were administered by submucosal injection at the level of the third molar immediately after surgery. All patients were operated on by the same surgeon; patients were paired for technical difficulty and amount of anesthetic solution. Use of supplementary analgesics (500 mg metamizole) and time to first postoperative use of a rescue drug were used to assess the analgesic effect of tramadol. Pain level on both sides (Group T and P) was recorded on a visual analog scale (VAS 010 cm) immediately after cessation of anesthetic effect and at 4, 8, 24, 48, and 72 hours postoperatively. Data were compared using the Wilcoxon test (p < 0.05). There was no difference in anesthetic blockade between groups. There were no differences in reported adverse effects. In the 72 hours following surgery, patients in group T took significantly fewer (p = 0.008) metamizole tablets (3.37 ± 4.65) than did those in group P (4.4 ± 3.71). Time to first dose of a rescue drug (in minutes) was longer in Group T (303.72 ± 416.01) than in Group P (185.4 ± 59.4) (p = 0.006). Tramadol reduced pain intensity values (VAS) significantly in Group T (3.55 ± 2.27) as compared to Group P (5.26 ± 2.49) after anesthetic effect had worn off (p = 0.001). Local administration of tramadol after oral surgery improves the quality of postoperative analgesia, but does not extend the duration of anesthetic action.
 
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Publishing Date
2010-09-02
 
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