Evaluation of caffeine versus codeine for pain and swelling management after implant surgeries: A triple blind clinical trial.

INTRODUCTION

There are controversies in recent studies over the application of NSAIDs for controlling pain and swelling after implant surgeries for osseointegration. The aim of this study was to compare caffeine-containing versus codeine-containing analgesics in relation to their anti-inflammatory and analgesic effects after dental implant surgeries.

MATERIALS AND METHODS

80 patients (40 in each group) were selected as the final sample size. Forty drug packs, which were formulated and made by the consultant pharmacist, each containing 10 capsules of acetaminophen caffeine (consisting of 300 mg of acetaminophen and 20 mg of caffeine), and another 40 packs, each containing 10 capsules of acetaminophen codeine (consisting of 300 mg acetaminophen and 20 mg codeine) were prepared. These drugs were administered randomly to patients 1 h before surgery and every 6 h afterward until 48 h, according to the protocol. The patients' pain severities were determined at 30-min, 3-h, 6-h, 12-h, 1-day, 2-day, and 1-week intervals. In addition, the swelling was evaluated after 1-day, 2-days, 3-days, and 1-week. Data were analyzed with Mann-Whitney, student's t, and chi-squared tests, using SPSS 11.

RESULTS

A total of 76 patients, including 38 males and 38 females, with a mean age of 41.06 ± 5 and an age range of 35-53 years, were studied. The pain severities in patients in the codeine group were significantly less than those in the caffeine group at 3-, 6-, and 12-h postoperative intervals (p = 0.001). However, the pain severities at the above intervals, even in caffeine group, were within the moderate pain severity range (VAS = 3-7). It is also interesting to note that the pain was at its maximum severity at the 6-h postoperative interval, and at its minimum at the 1-week interval. The severity of swelling was also evaluated in both groups, indicating that it was significantly less in the caffeine group at 1-, 2-, and 3-day postoperative intervals (p = 0.018).

CONCLUSION

According to this study, the codeine-containing analgesics are significantly more effective than caffeine-containing ones in reducing postoperative pain. It was also concluded that caffeine-containing analgesics are significantly more effective than codeine-containing ones in reducing postoperative swelling, which was reported to be significantly less within the first 3-days in the caffeine group. As a result, caffeine-containing analgesics are effective and acceptable in reducing both postoperative pain and swelling.