O efeito do paracetamol com codeína em comparação ao placebo no desconforto cirúrgico e nos sintomas de transtorno de estresse pós-traumático após a remoção do terceiro molar mandibular: um estudo clínico prospectivo randomizado

Abstract

This study investigated the effect of a single preemptive dose of 500 mg paracetamol plus 7.5 mg codeine phosphate on surgical discomfort, anxiety, post-traumatic stress disorder symptoms, and pain in mandibular third molar surgeries. Patients were randomly assigned and evaluated preoperatively using the State-Trait Anxiety Inventory, Dental Anxiety Scale (DAS), and anxiety visual analog scale (Anxiety-VAS). Immediately after surgery, patients were assessed using the self-perception questionnaire of dentoalveolar oral surgery, pain visual analog scale (Pain-VAS), and Anxiety-VAS. Patients also maintained a diary of postoperative pain at 3h, 6h, 9h, 12h, and at the beginning and end of day 1. At the postoperative review on the seventh day, patients completed the Impact of Event Scale – Revised (IES-R) regarding surgery. The study initially included 67 patients, with seven excluded during the evaluation process. A total of 60 surgeries involving a single mandibular third molar were performed, evenly distributed between the paracetamol-codeine group (n = 30) and the placebo group (n = 30).. The groups were similar in age, gender, surgical time, and difficulty of surgery according to the Pederson Scale. Anxiety measured by the STAI, DAS, and Anxiety-VAS did not differ among the groups. The preemptive medication tested showed similar effectiveness to placebo in controlling anxiety and pain, as well as in managing intraoperative discomfort or postoperative pain. A specific stressful surgical event was observed in 8 patients (13%) with clinical concern and 8 patients (13%) with probable post-traumatic stress disorder related to oral surgery. The paracetamol-codeine combination group did not show improved general IES-R scores. Higher levels of presurgical anxiety were associated with higher IES-R scores and greater surgical discomfort and pain. A single preemptive dose of 500 mg paracetamol plus 7.5 mg codeine phosphate does not provide benefits in mandibular third molar surgery. This study demonstrated a link between preoperative anxiety and both surgical discomfort and the development of post-traumatic stress disorder symptoms.