Nørholt S E, Aagaard E, Svensson P, Sindet-Pedersen S
Department of Oral and Maxillofacial Surgery; Royal Dental College, Aarhus University and Aarhus University Hospital, Denmark.
J Oral Maxillofac Surg. 1998 Apr;56(4):420-7; discussion 427-9. doi: 10.1016/s0278-2391(98)90705-4.
This study evaluated trismus, bite force, and pressure algometry as measures of analgesic efficacy after third molar removal.
Fifty-seven patients (36 females and 21 males) developed at least moderate pain after surgical removal of a mandibular third molar and were given either ibuprofen, 400 mg (n = 26), or placebo (n = 31) in a double-blind study. Pain intensity and pain relief were rated on a five-point verbal rating scale during the 4-hour study period. Recordings of trismus, bilateral pressure pain detection and tolerance thresholds, and bite force were performed before surgery, at medication, and hourly for 4 hours. Changes in the functional variables were calculated as percent change from baseline (before surgery).
The pain intensity and pain relief ratings showed significant differences between the ibuprofen- and placebo-treated patients in the 4-hour study period. The changes in trismus, bite force, and pressure pain thresholds were in accordance with these pain ratings. Pressure pain detection threshold on the operated side was significantly lower in the placebo-treated patients compared with the ibuprofen-treated patients 2 and 3 hours after medication, whereas pressure tolerance threshold showed a significant difference after 2 hours. Bite force on the operated side was significantly less reduced 3 hours after treatment with ibuprofen when compared with placebo.
The functional measures used support the results obtained by rating of pain intensity and pain relief, and could be of value as measures of the efficacy of an analgesic to reduce functional impairment caused by postoperative pain.
本研究评估了张口受限、咬合力和压力痛觉测定法作为第三磨牙拔除术后镇痛效果的测量指标。
57例患者（36例女性和21例男性）在拔除下颌第三磨牙后至少出现中度疼痛，在一项双盲研究中，他们被给予400毫克布洛芬（n = 26）或安慰剂（n = 31）。在4小时的研究期间，采用五点言语评定量表对疼痛强度和疼痛缓解情况进行评分。在手术前、用药时以及之后4小时每小时记录一次张口受限情况、双侧压力疼痛检测和耐受阈值以及咬合力。功能变量的变化以相对于基线（手术前）的百分比变化来计算。
在4小时的研究期间，布洛芬治疗组和安慰剂治疗组患者的疼痛强度和疼痛缓解评分显示出显著差异。张口受限、咬合力和压力痛阈值的变化与这些疼痛评分一致。与布洛芬治疗组患者相比，安慰剂治疗组患者在用药后2小时和3小时患侧的压力疼痛检测阈值显著更低，而压力耐受阈值在2小时后显示出显著差异。与安慰剂相比，布洛芬治疗3小时后患侧咬合力的降低明显更小。
所采用的功能测量指标支持通过疼痛强度和疼痛缓解评分获得的结果，并且作为评估镇痛药减轻术后疼痛所致功能障碍疗效的指标可能具有价值。
