The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 11 ( November, 2018 ) > List of Articles


Comparative Analgesic Effects of Ibuprofen, Celecoxib and Tramadol after third Molar Surgery: A Randomized Double Blind Controlled Trial

Akinwale O Akinbade, Kizito C Ndukwe, Foluso J Owotade

Keywords : Celecoxib, Ibuprofen, Postoperative pain, Third molar surgery, Tramadol

Citation Information : Akinbade AO, Ndukwe KC, Owotade FJ. Comparative Analgesic Effects of Ibuprofen, Celecoxib and Tramadol after third Molar Surgery: A Randomized Double Blind Controlled Trial. J Contemp Dent Pract 2018; 19 (11):1334-1340.

DOI: 10.5005/jp-journals-10024-2428

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Background: This study compared the effects of ibuprofen, celecoxib and tramadol on pain after surgical extraction of impacted mandibular third molars. Patients and methods: This double blind randomized controlled trial recruited 135 healthy subjects who required surgical extraction of impacted mandibular third molars, with a mean age of 26.51 ± SD 6.29 years. The subjects were randomized into three equal groups and given appropriate doses of each drug immediately after extraction. They continued the drugs up to 48 hours after extraction. Postoperative pain intensity was self-recorded by subjects at 4, 8, 16, 24 and 48 hours after extraction, using visual analogue scale (VAS). Data analysis involved descriptive statistics, 2-sample Wilcoxon Mann–Whitney U test and Kruskal Wallis rank test. Statistical analysis was done using intention-to-treat analysis. The mean VAS at each point of postoperative pain assessment was compared using one way analysis of variance (ANOVA) among the three groups. Statistical significance was inferred at p < 0.05. Results: The mean VAS score of the celecoxib group (32.35± SD 23.96) at 4 hours was the lowest among the three groups. This was followed by the ibuprofen group with mean VAS score of 38.96 ± SD 22.30. Whereas, the subjects in tramadol group experienced the highest VAS score (53.31 ± SD 23.30) at 4 hours. There was statistically significant difference in the mean VAS scores at 4 hours after extraction when the three groups were compared (p = 0.0039). Celecoxib group also had the lowest mean VAS scores at 8 hours, 24 hours and 48 hours after the extraction. None of the subjects in the ibuprofen and celecoxib groups reported any adverse effect of the analgesics, whereas 47.61% of the tramadol group did. Conclusion: Celecoxib was the most effective analgesic of the three studied drugs in controlling postoperative pain after mandibular third molar extraction in our subjects. It was closely followed by ibuprofen while tramadol was found to be the least effective. Clinical significance: The outcomes of this study suggest that celecoxib can be prescribed for effective control of postoperative pain after third molar surgery especially in patients with peptic ulcer disease who will not tolerate the adverse effect of traditional nonsteroidal anti-inflammatory drugs. It also shows that ibuprofen can be an analgesic of choice for patients who are not at risk of gastrointestinal complications of nonsteroidal anti-inflammatory drugs (NSAIDs). Tramadol could be considered for patients with milder postoperative pain after third molar surgery.

PDF Share
  1. Buyukkurt MC, Gungormus, Omer K. The effect of a single dose prednisolone with and without diclofenac on pain, trismus, and swelling after removal of mandibular molar. J Oral Maxillofac Surg. 2006; 64:1761-1766.
  2. Breivik H, Stubhaug A. Management of acute postoperative pain: Still a long way to go! Pain 2008:137(2):233-234.
  3. Leidholm R, Knutsson K, Lysell L, Rohlin M, Brickley M, Shepherd JP. The Outcomes of mandibular third molar removal and non-removal : a study of patient preferences using a multiattribute method. Acta Odontol Scand 2000; 58:293-298.
  4. Breivik H, Stubhaug A. Management of acute postoperative pain: Still a long way to go! Pain 2008:137(2):233-234.
  5. Apfelbaum J, Chen C, Mehta S, Gan T. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-540.
  6. Moore PA. Pain management in dental practice: tramadol vs codeine combinations. JADA 1999;130:1075-1079.
  7. Ofman JJ, Maclean CH, Straus WL, Morton SC, Berger ML, Roth EA. Meta-analysis of severe upper gastrointestinal complication of non-steroidal anti-inflammatory drugs. J Rheumatol 2002;29:804-812.
  8. Mohamed H. Rahman, Jane Beattie. Managing postoperative pain. The pharmaceutical Journal. 2005 July;275.
  9. Hunt RH, Harper S, Watson DJ, Yu C, Quan H, Lee M, Evans JK, Oxenius B. The gastrointestinal safety of the COX-2 selective inhibitor etoricoxib assessed by both endoscopy and analysis of upper gastrointestinal events. Am J Gastroenterol 2003;98:1725-1733.
  10. Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs 2000; 60:139.
  11. Desmueles JA, Piguet V, Collart L, Dayer P. Contribution of momoaminergic modulation to the analgesic effect of tramadol. Br J Clin Pharmacol 1996;41:7-12.
  12. Ong CKS, Seymour RA. An evidence-based update of the use of analgesics in dentistry. Periodontology 2000, 2008;46:143- 164.
  13. Ong CKS, Lirk P, Tan JMH, Sow BWY. The analgesic effect of intravenous versus oral tramadol for preventing postoperative pain after third molar surgery. J Oral Maxillofac Surg 2005; 63:1162-1168.
  14. Ong CKS, Lirk P, Tan CH, Seymour RA. An evidence based update on non-steroidal anti-inflammatory drugs. Clinical Medicine & Research 2007;5:19-34.
  15. Cooper SA. Single dose analgesic studies: the upside and downside sensitivity. In: Max M, Portenoy R, eds. Advances in Pain Research and Therapy. New York, NY: Raven Press 1991; 117-124.
  16. Pradip K Ghosh. Synopsis of Oral and Maxillofacial Surgery (An Update Overview). Jaypee Brothers Medical Publisher (P) Ltd India. First edition, Page 19 chapter 3.
  17. Katzung Betram G. Basic and Clinical Pharmacology. 10th edition, McGraw Hill pg 579.
  18. Celebrex(celecoxib capsules)[prescribing information]. Accessed February 1, 2012.
  19. Collart L, Luthy C, Dayer P. Partial inhibition of tramadol antinociceptive effect by naloxone in man. Brit J Clin Pharmacol 1993;35:73.
  20. Ritter JM, Lewis L, Mant TGK. Analgesics and the control of pain. In: A text book of clinical pharmacology. 4th ed., Arnold London, 1999. p. 216.
  21. Seymour RA, Hawkesford JE, Weldon M, Brewster D. An evaluation of different ibuprofen preparations in the control of postoperative pain after third molar surgery. Br J Clin Pharmacol. 1991;31:83-87.
  22. Ridgway D. Analgesic for acute pain meeting the United State Food and Drug Administration's requirement for proof of efficacy. Clin J Pain 2004;20:123-132.
  23. Oginni FO, Ugboko VI, Assam E, Ogunbodede EO. Postoperative complaints following impacted mandibular third molar surgery in Ile-Ife, Nigeria. SADJ 2002; 577:264-268.
  24. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Creminelli L, Santoro F. Assessing Postoperative discomfort after third molar surgery: A prospective study. J Oral Maxillofac Surg 2007;65:901-917.
  25. Zamiri B, Mousavideh K, Tajoddini M, Mohammadinezhad C, Aarabi AM. Comparison of ibuprofen, Celecoxib and Tramadol in relief of pain after extraction of mandibular third molar teeth. IRCMJ 2009;11:431-436.
  26. Cheung R, Kowalski K. Analgesic efficacy of celecoxib in postoperative oral surgery pain: A single-dose, two centre, randomized, double blind, active and placebo-controlled study. Clin Ther 2007;29(11):44.
  27. Mehlisch DR. A double-blind, placebo-controlled, single dose comparison of the analgesic activity of SC-58635 100 mg and 200 mg, and 400 mg, naproxen sodium 550 mg, and placebo in a postsurgical dental pain model. Study no N 49-97-02-027. New York, NY: Pfizer Inc; 1997.
  28. Doyle G, Jayawardena S, Ashraf E, Cooper SA. Efficacy and tolerability of nonprescription ibuprofen versus celecoxib for dental pain. J Clin Pharmacol 2002;42:912-919.
  29. Duthie DJ. Remifentanil and tramadol. Br J Anaesth 1998;81:51.
  30. Collins M, Young I, Sweeney P, Fenn GC, Stratford ME, Wilson A et al. The effect of tramadol on dento-alveolar surgical pain. Br J Oral Maxillofac Surg 1997;35:54-58.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.