J Oral Maxillofac Surg 65:1315-1320, 2007 Pre-Emptive Analgesic Effect of Tramadol After Mandibular Third Molar Extraction: A Pilot Study Amaury Pozos-Guillen, DDS, PhD,* Ricardo Martinez-Rider, DDS,† Patricia Aguirre-Banuelos, MS,‡ and Jose Perez-Urizar, PhD§ Purpose: We compared the efficacy of tramadol given before or immediately after surgical extraction of an impacted mandibular third molar under local anesthesia. Materials and Methods: In this prospective, randomized, controlled, double-blind pilot study, 3 groups of 20 patients each were included: tramadol preoperative, 100 mg intramuscularly (IM) 1 hour before surgery (group A); tramadol postoperative, 100 mg IM immediately after surgery (group B); and saline (group C). We evaluated intensity of pain and analgesic consumption as was requested. Results: The analgesic efficacy measured as complete relief of pain at 24 hours was 86% in the preemptive tramadol compared with 70% and 36% for postoperative tramadol administration and control group. A significant reduction in the consumption of analgesics was seen in preoperative group as compared with the postoperative and control groups. Adverse events were minimal and similar in all groups. Conclusions: This study suggests the preemptive use of tramadol as an alternative for the acute pain treatment after the removal of an impacted mandibular third molar carried out under local anesthesia. © 2007 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 65:1315-1320, 2007 Pain is a multidimensional sensory experience that is intrinsically unpleasant and associated with hurting and soreness. It may vary in intensity (mild, moderate, or severe), quality (sharp, burning, or dull), duration (transient, intermittent, or persistent), and referral (superficial or deep, localized or diffuse). Although it is essentially a sensation, pain has strong cognitive and emotional components; it is linked to, or de- scribed in terms of, suffering. In fact, the International Association for the Study of Pain (IASP), defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” 1 Patients typically associate dental care with pain, and an experience of poorly managed pain related to dental treatment can lead patients to avoid or post- pone treatment, as well as make them more difficult to treat. 2 Extraction of an impacted third molar is a model used commonly to test the efficacy of analge- sics for acute dental pain. 3 Pre-emptive analgesia is analgesia given before the painful stimulus begins. The reason for giving analgesia before the painful stimulus is to prevent or reduce sub- sequent pain. The effect of the pre-emptive analgesia is to prevent or reduce the development of any “memory” of the pain stimulus in the nervous system. The clinical interest is in the potential for improving postoperative pain management. 4 It has been found for a variety of different operations: tonsillectomy, inguinal hernia re- pair, cholecystectomy, orthopedic procedures, and mo- lar tooth extraction. Three classes of analgesic drugs have been used: local anesthetics, NSAIDs, and opioids Received from Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico. *Associate Professor, Department of Oral and Maxillofacial Sur- gery, Facultad de Estomatología. †Associate Professor, Department of Pharmacology, Facultad de Ciencias Químicas. ‡Professor and Head, Department of Oral and Maxillofacial Sur- gery, Facultad de Estomatología. §Associate Professor, Department of Pharmacology, Facultad de Ciencias Químicas. This study was partially supported and funded by Universidad Autónoma San Luis Potosí; C0-FAI-04-3.4 and C04-FAI-10-10.53. Address correspondence and reprint requests to Ms Aguirre- Banuelos: Facultad de Ciencias Quimicas, Universidad Autonoma de San Luis, Potosi, Av Dr Manuel Nava #6, Zona Universitaria, C.P. 78200; San Luis Potosi, S.L.P. Mexico; e-mail: paguirreb@uaslp.mx © 2007 American Association of Oral and Maxillofacial Surgeons 0278-2391/07/6507-0009$32.00/0 doi:10.1016/j.joms.2006.10.079 1315