Comparison of Low Pre-Emptive Oral Doses of Celecoxib Versus Acetaminophen for Postoperative Pain Management After Third Molar Surgery: A Randomized Controlled Study

Purpose: This study aimed to compare the pre-emptive analgesia of oral celecoxib with oral acetaminophen after surgical removal of the mandibular third molars. Materials and Methods: A randomized, double-blinded, placebo-controlled clinical trial was conducted to examine patients presenting with a mandibular third molar for extraction under local anesthesia. The participants were randomized to receive a preoperative oral dose of celecoxib or acetaminophen as the predictor variable. The primary outcome variable was postoperative pain measured on a visual analog scale at different time points. The secondary outcome variable was the amount of postoperative analgesic medication taken in both groups. Statistical analyses included descriptive statistics, the t test, and the Pearson chi(2) test. Significance was set at P < .05. The overall survival (interval to the first intake of ibuprofen) of the patients in each group was evaluated using Kaplan-Meier curves and log-rank analyses. Results: Sixty participants were randomly divided into either the celecoxib group or acetaminophen group. The postoperative pain scores in the celecoxib group were significantly lower than those in the acetaminophen group at 4, 6, 8, and 12 hours (P = .008, P = .001, P = .021, and P = .011, respectively). The number of patients who did not require analgesics in the celecoxib group was less than that in the acetaminophen group (P = .018). The average amount of rescue analgesic medication in the celecoxib group (0.6 +/- 0.8 dose) was significantly lower than that in the acetaminophen group (1.3 +/- 1.0 doses) (P = .002). The Kaplan-Meier curve indicated that celecoxib resulted in long-term survival of the patients who did not receive rescue analgesic medication (P = .0055). Conclusions: Celecoxib exhibits a significant pre-emptive analgesic effect, thereby reducing the use of postoperative analgesics after removal of the third molar. (C) 2019 American Association of Oral and Maxillofacial Surgeons