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How effective is preemptive analgesia on postoperative pain following third molar surgery? Review of literatures

PainThis summary is based on the article published in the Japanese Dental Science Review: Effectiveness of preemptive analgesia on postoperative pain following third molar surgery? Review of literatures (November 2013)

Akira Yamaguchi and Kimito Sano 


Surgery to remove the mandibular third molar is relatively invasive and is often associated with postoperative pain, swelling and trismus, which are frustrating for both patients and surgeons. In particular, postoperative pain increases the patient’s suffering and anxiety, and can disrupt the homeostasis of the circulatory and endocrine systems (1—3). Since it is also reported that postoperative pain can have a negative influence on wound healing, reliable and fast-onset analgesia is needed.

For the management of postoperative pain after removal of a tooth, nonsteroidal anti-inflammatory drugs (NSAIDs) are usually prescribed. However, once severe pain occurs, it can be difficult to successfully manage the pain with analgesics. Moreover, given the potential for acid NSAIDs to induce serious side effects in some patients, the type and amount of analgesic must be carefully selected (4).

Purpose of the Review

To investigate the effectiveness of preemptive analgesia for the management of postoperative pain after removal of a mandibular third molar and to find more effective analgesic methods.

Key Findings

The effect of preemptive analgesia on postoperative pain is more likely to be seen in thoracic, abdominal and orthopedic surgery in which it is firmly established that central sensitization is due to surgical tissue damage.

In the head and neck region, preemptive analgesia effects have been investigated in surgeries involving nociceptors of a relatively large area as in the case of tumor surgery, maxillary sinus surgery and orthognathic surgery. However, reports indicating central sensitization inhibition are limited (5-7).

In many of the studies, the preemptive use of NSAIDs before, tooth extraction demonstrated that the postoperative pain was better controlled beyond the expected, effect time, compared without such preemptive use. On the other hand, some studies reported that, compared to the administration before removal of the tooth, postoperative administration was, associated with better suppression of postoperative pain.

This suggests that in postoperative pain after, removal of mandibular third molars, peripheral sensitization caused by reactive inflammation, following the tooth extraction and secondary central sensitization are more important factors than, direct central sensitization caused by surgical tissue damage. Accordingly, when a mandibular third, molar is removed, central sensitization due to tissue damage should be suppressed by, preadministration of analgesics.

In order then to suppress postoperative peripheral sensitization, the, readministration of analgesics is considered more effective. Furthermore, although acid NSAIDs are, effective analgesics, the associated adverse events are of concern. Accordingly, acetaminophen (1000 mg), which, is devoid of anti-inflammatory effects but is a weak cyclooxygenase inhibitor, can be used for, preemptive analgesia administration.


  1. Omote K, Namiki A. Concept and strategy of acute pain: postoperative pain. Pain Clinic 1997;18:12—9 [in Japanese].
  2. Jo S. Postsurgical management. In: Furuya H, et al., editors. Dental anesthesiology. 5th ed., Tokyo: Ishiyaku Shuppan; 1997. p. 389—405 [in Japanese].
  3. Kaneko Y, Ichinohe T. Regional vicious circle of the pain. In: Ishikawa T, et al., editors. Clinical practice of the oral and Effectiveness of preemptive analgesia for third molar surgery 137 maxillofacial pain. 1st ed., Tokyo: Ishiyaku Shuppan; 1997. p. 69—74 [in Japanese].
  4. Yamashita H. Reye syndrome. J Pedod 1986; 90: 2397—407 [in Japanese].
  5. Kato S, Shinagawa A, Marumo A, Yoshino A, Hashimoto Y, Utiyama M. An investigation of postoperative pain relief undergoing oral surgery — is there preemptive analgesia by non-steroidal anti-inflammatory drugs? JSPA 1996; 9: 23—5 [in Japanese].
  6. Nagatsuka C, Ichinohe T, Kaneko Y. Preemptive effects of a combination of preoperative dclofenac, butorphanol and lidocaine on postoperative pain management following orthognathic surgery. Anesth Prog 2000; 47: 119—24 [in Japanese].
  7. Abe K, Yanaguchi A, Tsuchikawa K. Study on alleviation of postoperative pain in oral and maxillofacial surgery under general anesthesia. JJOMS 2001; 47: 225—31 [in Japanese].


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