www.ijcmr.com Section: Dentistry International Journal of Contemporary Medical Research Section: Dentistry ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 98.46 | Volume 7 | Issue 1 | January 2020 A7 Prevention of Post Operative Pain by Minimizing the use of Analgesic Consumption and Evaluation of Efficacy of Two Different Group of Intra Venous Pre-Emptive Analgesia in Lower Third Molar Surgery –A Study Arun K Goyal 1 , Durga Shankar Gupta 2 , Shilpi Srivastav 3 ORIGINAL RESEARCH ABSTRACT Background: This study compared intravenous ketorolac and tramadol for post-operative discomfort prevention following mandibular 3rd molar extractions. Preemptive analgesia may reduce postoperative analgesic need by preventing pain. Materials & methods: Forty patients who required surgical extraction of mandibular third molars were divided randomly into two groups. Group- I [Tramadol Group (n=20)] & Group- II [Ketorolac Group (n=20)] patients were given preemptive analgesia i.v. preoperatively. The parameters under evaluation were hourly postoperative pain intensity measurement for 12 postoperative hours, mean time after which rescue analgesic (acetaminophen) was taken within first 12 postoperative hours, total analgesic (acetaminophen) consumption over 5 day recovery period, and patient’s assessment of the surgical procedure. Results: The study's findings indicated that there existed no statistically significant disparity between each of the groups. A significant proportion of those in the ketorolac group said that the surgery was comparatively more favourable and less painful, as evidenced by their higher scores and reduced consumption of post-operative analgesics. Conclusion: There is no statistically significant difference in the two groups except global assessment. Clinically, we found that, ketorolac has a slightly better preemptive analgesia profile as the patients in ketorolac group experienced less pain, required rescue analgesic late, required less analgesics postoperatively and rated overall the procedure as relatively better. Keywords: Ketorolac; Preemptive Analgesia; Tramadol; Third Molar Surgery; Transalveolar Extraction. INTRODUCTION When third molars become impacted, transalveolar extraction is frequently necessary and is regarded as one of the most prevalent oral surgical procedures. [1] The most impacted teeth are third molar (98%) afterwards the permanent maxillary canine (1.3%) and mandibular premolar (0.11%). [2,3] Impacted mandibular 3rd molars could require extraction due to caries, infection, pain, pathologies, 2nd molar root resorption, etc. However, post-operative pain management is crucial for patients. [4,5] Moderate to severe pain is experienced following transalveolar extraction of the 3rd mandibular molar. Postoperatively, the intensity of the pain escalates, reaching its maximum within a time frame of 6 to 8 hours under the use of conventional local anaesthetics. Preventing post-operative pain is preferable than treating it since it is predictable. [6] First-author Crile introduced preemptive analgesia, the study found that inhibiting pain pathways before surgery reduces post-operative morbidity. By inhibiting the sensitization of periphery and central pain routes preemptive analgesia reduces the postoperative amplification of pain impulses. Pre- emptive analgesia was based on the idea that using analgesics before unpleasant stimuli might be better than afterward. The benefits of pre-operative analgesic management would outlast the drug's pharmacological lifespan. [7] Pharmacological medications were utilised to treat postoperative pain, a novel approach in this context is the proactive administration of the medication. Thus, prospective comparative research examined tramadol and ketorolac's preemptive pain relief following transalveolar extraction of mandibular 3rd molar. MATERIAL AND METHODS This research was conducted in Oral & Maxillofacial Surgery from June 2017 to March 2018, focusing on patients requiring transalveolar extraction of their lower wisdom teeth. The 40 adults requiring these extractions, ranging in age from 18 to 45, were divided equitably into two groups of 20. One group was administered 50 mg Tramadol pre- extraction intravenously, whereas the other cohort was given 30 mg Ketorolac. Adults between the ages of 18 and 45 who met the following inclusion criteria: Pederson difficulty index level 3 to 7 lower 1 Professor & Head, Department of Oral & Maxillofacial Surgery, VCSG Govt Medical College & Research Institute Srinagar Garhwal UK, 2 Professor, Department of Oral & Maxillofacial Surgery, Teerthankar Mahavir Dental College and Research Centre, Moradabad, 3 Reader, Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College, Moradabad UP, India Corresponding author: Dr. Durga Shankar Gupta, Professor, Department of Oral & Maxillofacial Surgery, Teerthankar Mahavir Dental College and Research Centre, Moradabad How to cite this article: Arun K Goyal, Durga Shankar Gupta, Shilpi Srivastav Prevention of post operative pain by minimizing the use of analgesic consumption and evaluation of efficacy of two different group of intra venous pre-emptive analgesia in lower third molar surgery –a study. International Journal of Contemporary Medical Research 2020;7(1):A7-A12. DOI: http://dx.doi.org/10.21276/ijcmr.2020.7.1.53