Effect of Preemptive Amitriptyline on Postoperative Pain after Impacted Mandibular Third Molar Extraction: A Randomized Clinical Trial
Effect of Amitriptyline Premedication on Pain Management in Patients After Impacted Mandibular Third Molar Surgery
Abstract
Objectives: Extraction of impacted mandibular third molars is one of the most common procedures in oral and maxillofacial surgery, which is usually associated with significant postoperative pain. This study aimed to evaluate the effect of preemptive amitriptyline on postoperative pain after impacted mandibular third molar extraction.
Materials and Methods: This randomized double-blind placebo-controlled clinical trial included 20 patients (n=40 teeth) who referred to the Department of Oral and Maxillofacial Surgery of Tabriz Dental School for bilateral extraction of impacted third molars. After obtaining ethical approval and informed consent, the participants were randomly assigned to two groups: the intervention group received 25 mg amitriptyline preemptively while the control group received a placebo. The primary outcomes included postoperative pain score measured by a visual analog scale (VAS), and the frequency of analgesics taken during the postoperative period. Data were analyzed by paired samples t-test (alpha=0.05).
Results: A total of 20 patients (10 males and 10 females) participated in this study, with a mean age of 22.2 years. The mean duration of surgery was almost similar in the two groups (P=0.847). The intervention group consumed significantly lower number of analgesics during the postoperative period than the control group (P<0.001). The time interval from surgery to the first analgesic intake was significantly longer in the amitriptyline group (P<0.001).
Conclusion: Preemptive consumption of amitriptyline can effectively reduce postoperative pain and analgesic consumption following impacted mandibular third molar extraction surgery.
2. Ahmad P, V'Vian T, Chaudhary FA, Chaudhary A, Haseeb AA, Yaqoob MA, et al. Pattern of third molar impactions in north-eastern peninsular Malaysia: A 10-year retrospective study. Niger J Clin Pract. 2021 Jul;24(7):1028-36.
3. Rezaei F, Imani MM, Khavid A, Nabavi A. Patterns of mandibular third molar impaction in an Iranian subpopulation. Pesqui. Bras. Odontopediatria Clín. Integr. 2020;20:e5411.
4. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F. Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Med Oral Patol Oral Cir Bucal. 2013 Jan;18(1):e140-5.
5. Yuasa H, Sugiura M. Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables. Br J Oral Maxillofac Surg. 2004 Jun;42(3):209-14.
6. Nehme W, Fares Y, Abou-Abbas L. Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial. BMC Oral Health. 2021 Aug;21(1):393.
7. Ku JK, Kim JY, Jun MK, Jeong YK, Huh JK. Influence of general and local anesthesia on postoperative pain after impacted third molar surgery. J Clin Med. 2021 Jun 17;10(12):2674.
8. Hosgor H, Coskunses FM, Tokuc B. Correlation between preoperative pressure pain assessments and anxiety and postoperative pain in impacted lower third molar surgery. J Korean Assoc Oral Maxillofac Surg. 2021 Feb;47(1):15-9.
9. Vranckx M, Fieuws S, Jacobs R, Politis C. Surgical experience and patient morbidity after third molar removal. J Stomatol Oral Maxillofac Surg. 2022 Jun;123(3):297-302.
10. Rizqiawan A, Lesmaya YD, Rasyida AZ, Amir MS, Ono S, Kamadjaja DB. Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient's Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study. Int J Dent. 2022 Jan;2022:7239339.
11. Weckwerth GM, Dionísio TJ, Costa YM, Zupelari-Gonçalves P, Oliveira GM, Torres EA, et al. Multifocal Analysis of Acute Pain After Third Molar Removal. Front Pharmacol. 2021 Apr 15;12:643874.
12. Kakoei S, Pardakhty A, Hashemipour MA, Larizadeh H, Kalantari B, Tahmasebi E. Comparison the pain relief of amitriptyline mouthwash with benzydamine in oral mucositis. J Dent (Shiraz). 2018 Mar;19(1):34-40.
13. Patel N, B Urolagin S, Haq MA, Patel C, Bhatt R, Girdhar G, et al. Anesthetic effect of 2% amitriptyline versus 2% lidocaine: A comparative evaluation. Cureus. 2023 Aug 13;15(8):e43405.
14. Su M, Liang L, Yu S. Amitriptyline therapy in chronic pain. Int Arch Clin Pharmacol. 2015;1(1):1-5.
15. Au AH, Choi SW, Cheung CW, Leung YY. The efficacy and clinical safety of various analgesic combinations for post-operative pain after third molar surgery: A systematic review and meta-analysis. PLoS One. 2015 Jun;10(6):e0127611.
16. Guaiana G, Barbui C, Hotopf M. Amitriptyline for depression. Cochrane Database Syst Rev. 2007 Jul;(3):CD004186.
17. Levine JD, Gordon NC, Smith R, McBryde R. Desipramine enhances opiate postoperative analgesia. Pain. 1986 Oct;27(1):45-9.
18. Unnissa Z, Fatima SS, Ahmed A, Banu A, Mohiuddin MJ, Mohiuddin S. Prophylactic role of amitriptyline after major lower limb fractures and in orthopedic surgeries in preventing post operative depression. Res J Pharm Technol. 2024;17(5):2289-95.
19. Neto AHF, Amorim M, Marinho AM. Does amitriptyline work as preemptive analgesia in abdominal hysterectomies?[6J]. Obstet Gynecol. 2019 May;133:108S.
20. Wong K, Phelan R, Kalso E, Galvin I, Goldstein D, Raja S, et al. Antidepressant drugs for prevention of acute and chronic postsurgical pain: early evidence and recommended future directions. Anesthesiology. 2014 Sep;121(3):591-608.
21. Sharav Y, Singer E, Schmidt E, Dionne RA, Dubner R. The analgesic effect of amitriptyline on chronic facial pain. Pain. 1987 Nov;31(2):199-209.
22. McQuay HJ, Carroll D, Glynn CJ. Low dose amitriptyline in the treatment of chronic pain. Anaesthesia. 1992 Aug;47(8):646-52.
23. Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum. 1986 Nov;29(11):1371-7.
24. Aminsobhani M, Meraji N, Ghorbanzadeh A, Ajami M, Hoseini SAS, Kharazifard MJ. Effect of local and application of amitriptyline and imipramine on teeth with irreversible pulpitis failed pulpal anesthesia: a randomized, double-blind, controlled trial. Dent Hypotheses. 2016 Oct;7(4):128-32.
| Issue | Vol 22 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Amitriptyline Pain Postoperative Analgesia Pain Management | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
