Estudo clínico comparativo de dose única pré-operatória de 50mg de rofecoxib ou diclofenado sódico no controle da dor após tratamento endodôntico

Abstract

Pain management following endodontic therapy is an essential part of patient treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase enzymes that abolish the effects of prostaglandins and consequently exert potent anti-inflammatory and analgesic activity. The aim of the present pilot study was to test the efficacy of prior drug administration in the control of postoperative pain following endodontic therapy. Informed consent was obtained prior to their participation. Sixty patients requiring endodontic therapy for asymptomatic anterior teeth were randomly assigned to to three randomized groups. Treatment groups did not significantly differ (p > 0.05). Prepared capsules of a single dose of placebo (n=20), rofecoxib 50mg (a COX-2 selective inhibitor; n=20) or diclofenac 50 mg (a non-specific COX inhibitor; n=20) were administered 30 min before dental treatment. All endodontic therapies were completed using an anaesthetic volume ≤ 1,8ml. There were no statistically significant differences in volume of local anesthetic used (p=0.89) or duration of the operation proccedure(p=0.69). Pain intensity was evaluated by a 100mm Visual Analogical Score (VAS) and Visual Color Categorical Score (VCCS) at 0, 4, 6, 8, 10, 12 and 24 hours after NSAIDs or placebo administration by repeated measures ANOVA. It adds sum of pain intensity differences (SPID) it was evaluated by ANOVA in the experimental times 4,6,8,10,12 and 24 hours multiplying the score difference with the baseline for the respective experimental time and adding cumulatively with the values obtained in the previous times. Medication consumption supports and pain intensity through the frequency of the percentages among the groups was analyzed through the qui-square test for evaluation of tendencies at 5% signifcance level. Repeated measures ANOVA of the pain intensity obtained through the analogical visual scale indicated a difference among the treatments (p=0,08). The patient percentage reporting VAS≥23 mm in the placebo was significant (p<0,0001) in the periods between the octave and tenth-second hour. Summed pain intensity differences (SPID) it demonstrated that rofecoxib 50 mg administered pre-operatory was effective in the control of the pain (p <0,0001) versus placebo. This effect was important for SPID-10, SPID-12 e SPID-24. The sodic diclofenac 50 mg group it was not different from the placebo, although a smaller pain level has been observed in that group in the initial periods of time and in the tenth and tenth-second hour of the experimentation. Reports of collateral effects were not observed by the patients in the different times and experimental groups. After 24 hours of the experimentation, it was not told need of support medication use. These results suggest that single a pre-operatory dose of the cyclooxygenase inibitors tested may be sufficient to prevent post-endodontic pain.