Vicentini Carllini Barroso, Ramacciato Juliana Cama, Groppo Francisco Carlos, Teixeira Rubens Gonçalves, Motta Rogério Heládio Lopes
Oral and Maxillofacial Surgery Area, Instituto Tocantinense Presidente Antônio Carlos Porto (ITPAC PORTO), Porto Nacional, TO, Brazil.
Pharmacology, Anesthesiology and Therapeutics Area, São Leopoldo Mandic Institute and Research Center, Rua José Rocha Junqueira, 13, Campinas, 13045-755 SP, Brazil.
Oral Maxillofac Surg. 2018 Jun;22(2):177-183. doi: 10.1007/s10006-018-0687-9. Epub 2018 Mar 13.
The aim of the present study was to compare two therapeutic protocols of dexamethasone for the prevention of postoperative swelling, pain, and other complications after the extraction of impacted third molars, in a prospective, randomized, crossover, double-blinded clinical trial.
Fifty patients with symmetrical impaction of third molars were randomly assigned to two different protocols of dexamethasone for each side. Patients underwent two sessions performed at a 21-day interval. In group 1, patients took 8 mg of dexamethasone orally 1 h before the procedure, and in group 2, 4 mg dexamethasone orally 1 h before and 24 h after the procedure. Surgery duration, volume of local anesthetics, surgical technique, and rescue medication were standardized. Postoperative pain was evaluated using a visual analog scale (VAS) at predefined times: before operation; immediately after; 1, 2, 4, and 12 h; and 1, 2, 3, and 7 days after operation. The patients were also instructed to take notes of the number of rescue medication tablets taken. Edema and mouth opening were clinically evaluated before surgery and in the postoperative period (second and seventh postoperative days).
There were no significant differences between groups for VAS scales (p = 0.5048), but the use of rescue medication was significantly lower in group 1 (p = 0.006). None statistically significant differences (p > 0.05) were observed between groups in any of the time points for all measurements of edema. However, the mouth opening limitation (DIINC) was bigger (p = 0.0069) for group 1 at 2 days.
Pre-emptive use of different dexamethasone regimens had a beneficial effect against pain, edema, and mouth opening limitation, especially when administered at an 8 mg concentration, which suggests that this protocol may also be efficient for more invasive surgery.
本研究旨在通过一项前瞻性、随机、交叉、双盲临床试验，比较两种地塞米松治疗方案预防阻生第三磨牙拔除术后肿胀、疼痛及其他并发症的效果。
50例双侧第三磨牙对称阻生的患者被随机分为两组，每组的两侧采用不同的地塞米松治疗方案。患者接受两个疗程，间隔21天。第1组患者在手术前1小时口服8毫克地塞米松，第2组患者在手术前1小时和术后24小时各口服4毫克地塞米松。手术时间、局部麻醉药用量、手术技术和急救药物均标准化。在预定时间使用视觉模拟量表（VAS）评估术后疼痛：手术前；术后即刻；术后1、2、4和12小时；以及术后1、2、3和7天。还指导患者记录服用的急救药物片数。在手术前和术后（术后第2天和第7天）对水肿和开口度进行临床评估。
两组VAS量表无显著差异（p = 0.5048），但第1组急救药物的使用显著低于第2组（p = 0.006）。在所有水肿测量的任何时间点，两组之间均未观察到统计学显著差异（p>0.05）。然而，第1组在术后2天的开口受限（DIINC）更大（p = 0.0069）。
预先使用不同的地塞米松方案对疼痛、水肿和开口受限有有益作用，尤其是以8毫克浓度给药时，这表明该方案对更具侵入性的手术可能也有效。
