Palabras clave
Arginina
Analgesia
Cirugía Oral
Tercer molar
Cómo citar
Resumen
Introducción: El dolor postoperatorio después de la extracción de terceros molares mandibulares es una queja común, que requiere enfoques efectivos para su manejo. Objetivo: Presentar un estudio Piloto proporcionando información sobre el manejo del dolor postoperatorio luego de la extracción de terceros molares mandibulares, comparando la eficacia analgésica y el inicio de acción del ibuprofeno asociado a arginina con el ibuprofeno solo. Metodología: Estudio clínico prospectivo, aleatorizado, de boca dividida, ciego, en el que se incluyeron 14 pacientes ambulatorios, con un total de 28 terceros molares mandibulares simétricos bilaterales. Cada paciente fue sometido a cirugías separadas con un intervalo regular de 15 días entre ellas. Al final de cada etapa, los pacientes fueron medicados con ibuprofeno (600 mg) asociado con arginina (555 mg) o ibuprofeno solo (600 mg). Los participantes del estudio registraron la intensidad del dolor utilizando la Escala Numérica Analógica Visual (EVA) durante 3 días. Resultados: El inicio de la analgesia mostró diferencias estadísticamente significativas, evaluadas como el tiempo medio hasta el alivio significativo del dolor se logró después de 24,8 minutos con ibuprofeno asociado a arginina, y dentro de los 40,2 minutos con ibuprofeno (p = 0,0245). La calidad analgésica fue similar entre los dos grupos (p = 0,2156). Conclusiones: El ibuprofeno con arginina proporciona analgesia, lográndose tasas de alivio del dolor similares a la formulación convencional, pero con un inicio del alivio del dolor significativamente más rápido. Los resultados corroboraron los resultados de estudios previos sobre la eficacia del ibuprofeno en el dolor agudo después de la extracción quirúrgica de terceros molares mandibulares impactados.
Citas
1. Al Lawati H, Jamali F. Onset of Action and Efficacy of Ibuprofen Liquigel as Compared to Solid Tablets: A Systematic Review and Meta-Analysis. J Pharm Pharm Sci. 2016; 19(3): 301-311. doi: https://doi.org/10.18433/J3B897
2. Aziato L, Florence D, Kissinger M, Asamani J, Clegg-Lamptey J. Validation of three pain scales among adult postoperative patients in Ghana. BMC Nursing. 2015; 14(1): 42-50. doi: https://doi.org/10.1186/s12912-015-0094-6
3. Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2013; (12): CD004624. doi: https://doi.org/10.1002/14651858.CD004624.pub2
4. Beaver WT. Review of the analgesic efficacy of ibuprofen. Int J Clin Pract Suppl. 2003; (135): 13-17. https://pubmed.ncbi.nlm.nih.gov/12723741/
5. Best AD, De Silva RK, Thomson WM, Tong DC, Cameron CM, De Silva HL. Efficacy of Codeine When Added to Paracetamol (Acetaminophen) and Ibuprofen for Relief of Postoperative Pain After Surgical Removal of Impacted Third Molars: A Double-Blinded Randomized Control Trial. J Oral Maxillofac Surg. 2017; 75(10): 2063-2069. doi: https://doi.org/10.1016/j.joms.2017.04.045
6. Black P, Max B, Desjardins P, Norwood T, Ardia A, Pallotta T. A randomized, double-blind, placebo-controlled comparison of the analgesic efficacy, onset of action, and tolerability of ibuprofen arginate and ibuprofen in postoperative dental pain. Clin Ther. 2002; 24(7): 1072-1089. doi: https://doi.org/10.1016/S0149-2918(02)80020-0
7. Silva B, Rovere-Querini P, Sciorati C, Manfredi AA, Clementi E. Nitric oxide: emerging concepts about its use in cell-based therapies. Expert Opin Investig Drugs. 2007; 16(1): 33-43. doi: https://doi.org/10.1517/13543784.16.1.33
8. Castelo-Branco C, Casals G, Haya J, Cancelo MJ, Manasanch J. Efficacy and safety of Ibuprofen arginine in the treatment of primary dysmenorrhoea. Clin Drug Investig. 2004; 24(7): 385-393. doi: https://doi.org/10.2165/00044011-200424070-00002
9. Cattaneo D, Clementi E. Clinical pharmacokinetics of ibuprofen arginine. Curr Clin Pharmacol. 2010; 5(4): 239-245. doi: https://doi.org/10.2174/157488410793352012
10. Cooper SA, Beaver WT. A model to evaluate mild analgesics in oral surgery outpatients. Clin Pharmacol Ther. 1976; 20(2): 241-250. doi: https://doi.org/10.1002/cpt1976202241
11. Cooper SA, Needle SE, Kruger GO. Comparative analgesic potency of aspirin and ibuprofen. J Oral Surg. 1977; 35(11): 898-903. https://pubmed.ncbi.nlm.nih.gov/269932/
12. Cooper SA, Schachtel BP, Goldman E, Gelb S, Cohn P. Ibuprofen and acetaminophen in the relief of acute pain: a randomized, double-blind, placebo-controlled study. J Clin Pharmacol. 1989; 29(11): 1026-1030. doi: https://doi.org/10.1002/j.1552-4604.1989.tb03273.x
13. Cooper SA. Models for clinical assessment of oral analgesics. Am J Med. 1983; 75(5A): 24-29. doi: https://doi.org/10.1016/0002-9343(83)90229-2
14. Coulthard P, Patel N, Bailey E, Coulthard MB. Measuring pain after oral surgery. Oral Surgery. 2014; 7(4): 203-208. doi: http://dx.doi.org/10.1111/ors.12075
15. Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five-parallel-group, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain. 2011; 152(3): 632-642. doi: https://doi.org/10.1016/j.pain.2010.12.012
16. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009; (3): CD001548. doi: https://doi.org/10.1002/14651858.CD001548.pub2
17. Desjardins P, Black P, Papageorge M , Norwood T, Shen D, Norris L, et al. Ibuprofen arginate provides effective relief from postoperative dental pain with a more rapid onset of action than ibuprofen. Eur J Clin Pharmacol. 2002; 58(6): 387-394. doi: https://doi.org/10.1007/s00228-002-0491-0
18. Ettlin D, Ettlin A, Bless K, Puhan M, Bernasconi C, Tillmann H, et al,. Ibuprofen arginine for pain control during scaling and root planing: a randomized, triple‐blind trial. J Clin Periodontol. 2006; 33(5): 345-350. doi: https://doi.org/10.1111/j.1600-051X.2006.00918.x
19. Franco-de la Torre L, Figueroa-Fernández NP, Franco-González DL, Alonso-Castro ÁJ, Rivera-Luna F, Isiordia-Espinoza MA. A Meta-Analysis of the Analgesic Efficacy of Single-Doses of Ibuprofen Compared to Traditional Non-Opioid Analgesics Following Third Molar Surgery. Pharmaceuticals (Basel). 2021; 14(4): 360. doi: https://doi.org/10.3390/ph14040360
20. Habib S. Matthews R, Scully C, MrcPath B, Levers P, Shepherd B. A study of the comparative efficacy of four common analgesics in the control of postsurgical dental pain. Oral Surg Oral Med Oral Pathol. 1990; 70(5): 559-563. doi: https://doi.org/10.1016/0030-4220(90)90396-A
21. Huskisson EC. Measurement of pain. Lancet. 1974; 2(7889): 1127-1131. doi: https://doi.org/10.1016/s0140-6736(74)90884-8
22. Irvine J, Afrose A, Islam N. Formulation and delivery strategies of ibuprofen: challenges and opportunities. Drug Dev Ind Pharm. 2018; 44(2): 173-183. doi: https://doi.org/10.1080/03639045.2017.1391838
23. Jayawardena S, Leyva R, Kellstein D. Safety of a novel formulation of ibuprofen sodium compared with standard ibuprofen and placebo. Postgrad Med. 2015; 127(1): 33-37. doi: https://doi.org/10.1080/00325481.2015.993268
24. Karcioglu O, Hakan T, Ozgur D, Ozlem D. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018; 36(4): 707-714. doi: https://doi.org/10.1016/j.ajem.2018.01.008
25. La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Cristalli MP. Effects of ibuprofen administration timing on oral surgery pain: A randomized clinical trial. Oral Dis. 2022; 28(3): 796-804. doi: https://doi.org/10.1111/odi.13781
26. Laska EM, Sunshine A, Marrero I, Olson N, Siegel C, McCormick N. The correlation between blood levels of ibuprofen and clinical analgesic response. Clin Pharmacol Ther. 1986; 40(1): 1-7. doi: https://doi.org/10.1038/clpt.1986.129
27. Li H, Mandema J, Wada R, Jayawardena S, Desjardins P, PhD, Doyle G, et al. Modeling the onset and offset of dental pain relief by ibuprofen. J Clin Pharmacol. 2012; 52(1): 89-101. doi: https://doi.org/10.1177/0091270010389470
28. Lisboa AH, Pilatti GL. Analgesia pós-operatória em exodontias de terceiros molares mandibulares inclusos: estudo comparativo com dexametasona, etoricoxibe e ibuprofeno associado à arginina. RGO, Rev Gaucha Odontol. 2013; 61(3): 335-340. http://revodonto.bvsalud.org/scielo.php?script=sci_arttext&pid=S1981-86372013000300005
29. Martin W, Koselowske G, Töberich H, Kerkmann T, Mangold B, Augustin J. Pharmacokinetics and absolute bioavailability of ibuprofen after oral administration of ibuprofen lysine in man. Biopharm Drug Dispos. 1990; 11(3): 265-278. doi: https://doi.org/10.1002/bdd.2510110311
30. Mehlisch DR, Ardia A, Pallotta T. A controlled comparative study of ibuprofen arginate versus conventional ibuprofen in the treatment of postoperative dental pain. J Clin Pharmacol. 2002; 42(8): 904-911. doi: https://doi.org/10.1177/009127002401102821
31. Moore AR, Derry S, Straube S, Ireson-Paine J, Wiffen PJ. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain. 2014; 155(1): 14-21. doi: https://doi.org/10.1016/j.pain.2013.08.013
32. Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc. 2013; 144(8): 898-908. doi: https://doi.org/10.14219/jada.archive.2013.0207
33. Pell GJ, Gregory BT. Impacted mandibular third molars classification and modified technique for removal. Dental Dig. 1933; 39: 330-338. In: Prado R, Salim MAA. Cirurgia bucomaxilofacial: diagnóstico e tratamento. 2 ed. Rio de Janeiro: Guanabara Koogan; 2018. ISBN: 978-85-277-3243-7
34. Pereira Filho VA, Trivellato AE, Silva AC, Moraes M, Moreira RWF, Ambrosane GMB. Estudo comparativo sobre a eficácia de duas drogas de ação analgésica (Ibuprofeno e Ibuprofeno-arginina) após extração de terceiros molares inferiores inclusos. Revista Odontológica do Brasil Central. 2000; 9(27): 58-62. https://www.robrac.org.br/seer/index.php/ROBRAC/article/view/249
35. Ramos EU, Benetti LP, Oliveira JCS, Bassi APF. Single-Dose Ibuprofen-Arginine as a Preventive for Pain, Edema, and Trismus After Impacted Lower Third Molar Surgery: A Randomized Split-Mouth Clinical Trial. Eur J Dent. 2022; 16(2): 396-402. doi: https://doi.org/10.1055/s-0041-1735910
36. Reed MD, Van Nostran W. Assessing pain intensity with the visual analog scale: a plea for uniformity. J Clin Pharmacol. 2014; 54(3): 241-244. doi: https://doi.org/10.1002/jcph.250
37. Seymour RA, Blair GS, Wyatt FAR. Post-operative dental pain and analgesic efficacy. Part I. Br J Oral Maxillofac Surg. 1983; 21(4): 290-297. doi: https://doi.org/10.1016/0007-117X(83)90017-3
38. Seymour RA, Walton JG. Pain control after third molar surgery. Int J Oral Surg. 1984; 13(6): 457-485. doi: https://doi.org/10.1016/S0300-9785(84)80017-4
39. Shin D, Lee S, Ha Y , Choi Y , Kim J,Se-Rin P, et al. Pharmacokinetic and pharmacodynamic evaluation according to absorption differences in three formulations of ibuprofen. Drug Des Devel Ther. 2017; 11: 135-141. doi: https://doi.org/10.2147/DDDT.S121633
40. Lyngstad G, Skjelbred P, Swanson DM, Skoglund LA. Analgesic effect of oral ibuprofen 400, 600, and 800 mg; paracetamol 500 and 1000 mg; and paracetamol 1000 mg plus 60 mg codeine in acute postoperative pain: a single-dose, randomized, placebo-controlled, and double-blind study. Eur J Clin Pharmacol. 2021; 77(12): 1843-1852. doi: https://doi.org/10.1007/s00228-021-03231-9
41. Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev. 2008; (4): CD004602. doi: https://doi.org/10.1002/14651858.CD004602.pub2
42. Christo PJ. Opioid effectiveness and side effects in chronic pain. Anesthesiol Clin North America. 2003; 21(4): 699-713. doi: https://doi.org/10.1016/s0889-8537(03)00087-7
43. Esper RC. Tópicos selectos en anestesiología. Distrito Federal, México; 2008: 291-302. [Internet] [Consultado 20 de enero de 2023] Available from: https://pt.scribd.com/document/326588497/Topicos-Selectos-en-Anestesiologia
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2025 Samara Caroline Fernandes Galvani, Isabela Potratz Auler, Isabela Trarbach Gomes, Belinda Ivett Beltrán-Salinas, Alejandra Giselle Juárez Rebollar, Daniela Nascimento Silva, Rossiene Motta Bertollo, Sabine Girod, Martha Alayde Alcantara Salim Venancio