Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of pretreatment gabapentin and pregabalin to control postoperative endodontic pain - a double-blind, randomized clinical trial

  • Received : 2022.07.14
  • Accepted : 2022.09.18
  • Published : 2022.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Postoperative endodontic pain is an enigma for the dentist. This study aimed to evaluate the analgesic effect of 300 mg gabapentin or 75 mg pregabalin in reducing postoperative endodontic pain compared with a placebo. Methods: Ninety patients who needed root canal treatment with an initial numerical rating scale (NRS) pain score of > 4 (T0) were randomly divided into three groups (n=30). Patients were then administered either 300 mg gabapentin (group A), 75 mg pregabalin (group B), or a placebo (group C) 30 min prior to the start of endodontic treatment. A single operator performed single-visit endodontics, and pain was evaluated immediately after endodontic treatment (T1) and at 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5), 48 h (T6), and 72 h (T7) using the NRS. Ibuprofen/paracetamol (400 mg/325 mg) was administered as a rescue dose if needed. Results: Pregabalin performed significantly better when compared with gabapentin at all time points except at 72 h after treatment (P=0.170). The placebo group showed significantly higher pain scores than the other two groups. The percentage of pain relief was maximum for pregabalin (92.1%), followed by gabapentin (87.6%) and placebo (69.1%) at 72 h after treatment completion. Conclusion: This study showed that pretreatment with a single dose of pregabalin and gabapentin both had greater analgesic effects than a placebo. They can be effectively used to reduce postoperative endodontic pain.

Keywords

References

  1. Keiser K. Strategies for managing the endodontic pain patient. Tex Dent J 2003; 120: 250-7.
  2. Alonso-Ezpeleta LO, Gasco-Garcia C, Castellanos-Cosano L, Martin-Gonzalez J, Lopez-Frias FJ, Segura-Egea JJ. Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: comparison of three different obturation techniques. Med Oral Patol Oral Cir Bucal 2012; 17: e721-7.
  3. Arias A, de la Macorra JC, Hidalgo JJ, Azabal M. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 2013; 46: 784-93. https://doi.org/10.1111/iej.12059
  4. Kumar G, Sangwan P, Tewari S. Effect of premedication on postoperative pain after root canal therapy in patients with irreversible pulpitis: a systematic review and meta-analysis. J Dent Anesth Pain Med 2021; 21: 397-411. https://doi.org/10.17245/jdapm.2021.21.5.397
  5. Harrison JW, Gaumgartner JC, Svec TA. Incidence of pain associated with clinical factors during and after root canal therapy. Part 1. Interappointment pain. J Endod 1983; 9: 384-7. https://doi.org/10.1016/S0099-2399(83)80190-3
  6. Nagendrababu V, Pulikkotil SJ, Jinatongthai P, Veettil SK, Teerawattanapong N, Gutmann JL. Efficacy and safety of oral premedication on pain after nonsurgical root canal treatment: a systematic review and network meta-analysis of randomized controlled trials. J Endod 2019; 45: 364-71. https://doi.org/10.1016/j.joen.2018.10.016
  7. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/ pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007; 104: 1545-56. https://doi.org/10.1213/01.ane.0000261517.27532.80
  8. Makkar JK, Jain K, Kuberan A, Balasubramanian M, Bhatia N, Singh PM. Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial. Indian J Anaesth 2019; 63: 895-9. https://doi.org/10.4103/ija.ija_363_19
  9. Siqueira JF, Barnett F. Interappointment pain: mechanisms, diagnosis, and treatment. Endodontic Topics 2004; 7: 93-109. https://doi.org/10.1111/j.1601-1546.2004.00062.x
  10. Ehrmann EH, Messer HH, Clark RM. Flare-ups in endodontics and their relationship to various medicaments. Aust Endod J 2007; 33: 119-30. https://doi.org/10.1111/j.1747-4477.2007.00087.x
  11. Chang CY, Challa CK, Shah J, Eloy JD. Gabapentin in acute postoperative pain management. Biomed Res Int 2014; 2014: 631756. https://doi.org/10.1155/2014/631756
  12. Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids: choice of agent, dose, timing, and effects on chronic postsurgical pain. Anesthesiology 2013; 119: 1215-21. https://doi.org/10.1097/ALN.0b013e3182a9a896
  13. Guay DR. Pregabalin in neuropathic pain: a more "pharmaceutically elegant" gabapentin? Am J Geriatr Pharmacother 2005; 3: 274-387. https://doi.org/10.1016/j.amjopharm.2005.12.008
  14. Praveen R, Thakur S, Kirthiga M. Comparative evaluation of premedication with ketorolac and prednisolone on post endodontic pain: a double-blind randomized controlled trial. J Endod 2017; 43: 667-73. https://doi.org/10.1016/j.joen.2016.12.012
  15. Mesgarani A, Mirzaeerad S, Moghadamnia AA, Mahyar M, Poorsattar Bejeh Mir A, Ehsani M. Analgesic effects of gabapentin and ibuprofen on the pain in post therapy of root canal; a randomized double-blind clinical trial. Caspian J Dent Res 2014; 3: 8-13.
  16. Londhe SM, Garge HG. Single visit root canal treatment. Med J Armed Forces India 2007; 63: 273-4. https://doi.org/10.1016/S0377-1237(07)80153-5
  17. Farrar JT, Polomano RC, Berlin JA, Strom BL. A comparison of change in the 0-10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity. Anesthesiology 2010; 112: 1464-72. https://doi.org/10.1097/ALN.0b013e3181de0e6d
  18. Lavand'homme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 2005; 103: 813-20. https://doi.org/10.1097/00000542-200510000-00020
  19. Gottschalk A. Update on preemptive analgesia. Tech Reg Anesth Pain Manag 2003; 7: 116-21. https://doi.org/10.1016/S1084-208X(03)00040-5
  20. Hu J, Huang D, Li M, Wu C, Zhang J. Effects of a single dose of preoperative pregabalin and gabapentin for acute postoperative: a network meta-analysis of randomized controlled trials. J Pain Res 2018; 11: 2633-43. https://doi.org/10.2147/JPR.S170810
  21. Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for post-operative pain. Anaesthesia 2015; 70: 1186-204. https://doi.org/10.1111/anae.13179
  22. Saraswat V Arora V. Preemptive gabapentin vs pregabalin for acute postoperative pain after surgery under spinal anaesthesia. Indian J Anaesth 2008; 52: 829-34.
  23. Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod 2008; 34: 652-5. https://doi.org/10.1016/j.joen.2008.02.017
  24. Isik B, Yaman S, Aktuna S, Turan A. Analgesic efficacy of prophylactic gabapentin and lornoxicam in preventing postendodontic pain. Pain Med 2014; 15: 2150-5. https://doi.org/10.1111/pme.12536
  25. Narita N, Kumar N, Cherkas PS, Chiang CY, Dostrovsky JO, Coderre TJ et al. Systemic pregabalin attenuates sensorimotor responses and medullary glutamate release in inflammatory tooth pain model. Neuroscience 2012; 218: 359-66. https://doi.org/10.1016/j.neuroscience.2012.05.016
  26. Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog 2012; 59: 90-103. https://doi.org/10.2344/0003-3006-59.2.90
  27. Bhagwat S, Mehta D. Incidence of post-operative pain following single visit endodontics in vital and non-vital teeth: an in vivo study. Contemp Clin Dent 2013; 4: 295-302. https://doi.org/10.4103/0976-237X.118352
  28. Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet 2010; 49: 661-9. https://doi.org/10.2165/11536200-000000000-00000
  29. Robertson K, Marshman LAG, Plummer D, Downs E. Effect of gabapentin vs pregabalin on pain intensity in adults with chronic sciatica: a randomized clinical trial. JAMA Neurol 2019; 76: 28-34. https://doi.org/10.1001/jamaneurol.2018.3077
  30. Karri SR, Jayaram K, Kumar A, Durga P. Comparison of efficacy of gabapentin and memantine premedication in laparoscopic cholecystectomies for postoperative pain relief - a randomised placebo controlled trial. Indian J Anaesth 2021; 65: 539-44. https://doi.org/10.4103/ija.IJA_140_21
  31. Yasaei R, Katta S, Saadabadi A. Gabapentin. In: StatPearls. Treasure Island (FL), StatPearls Publishing. 2022.
  32. Eftekharsadat B, Babaei-Ghazani A, Habibzadeh A. The efficacy of 100 and 300 mg gabapentin in the treatment of carpal tunnel syndrome. Iran J Pharm Res 2015; 14: 1275-80.
  33. Cortes-Martinez LA, Cardoso-Garcia LE, Galvan-Talamantes Y, Morales-Maza J, Rosas-Sanchez MA, Vargas-Aguilar DM, et al. Pregabalin as a premedication for anxiety in patients undergoing plastic surgery: randomized double-blind, placebo-controlled study. Cir Cir 2020; 88: 548-53.
  34. Rajappa GC, Vig S, Bevanaguddaiah Y, Anadaswamy TC. Efficacy of pregabalin as premedication for post-operative analgesia in vaginal hysterectomy. Anesth Pain Med 2016; 6: e34591. https://doi.org/10.5812/aapm.34591
  35. Bartholdy J, Hilsted KL, Hjortsoe NC, Engbaek J, Dahl JB. Effect of gabapentin on morphine demand and pain after laparoscopic sterilization using Filshie clips. A double blind randomized clinical trial. BMC Anesthesiol 2006; 6:12. https://doi.org/10.1186/1471-2253-6-12