Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Med Princ Pract 2011;20:470–476 DOI: 10.1159/000327658 Postoperative Analgesia in Impacted Third Molar Surgery: The Role of Preoperative Diclofenac Sodium, Paracetamol and Lornoxicam Aysegul Mine Tuzuner Oncul   a Duygu Yazicioglu   b Zekeriyya Alanoglu c Samimi Demiralp a Adnan Ozturk a Cahit Ucok a a  Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, b  Faculty of Dentistry, Dental Clinics, and c  Department of Anesthesiology and Reanimation, Medical Faculty, Ankara University, Ankara, Turkey intravenous paracetamol and lornoxicam effectively de- creased the pain scores. The patients were satisfied with the three postoperative pain management regimens. Copyright © 2011 S. Karger AG, Basel Introduction Impacted third molar surgery is one of the most fre- quently performed interventions in the field of oral and maxillofacial surgery and postoperative pain manage- ment is a vital issue. Particularly, demonstration of the negative effects of insufficient administration of analge- sia in cases of acute pain on cardiovascular, pulmonary and emotional systems aroused interest and highlighted the clinical importance of this subject [1, 2]. During surgery, tissue damage, inflammation and other noxious stimuli trigger a range of changes in the peripheral nervous system. It has been well documented that nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving postoperative pain. The NSAIDs affect the site of injury by acting peripherally and pre- operative administration of NSAIDs reduces this tissue damage. The NSAIDs inhibit the production of arachi- donic acid metabolites such as prostaglandins and throm- Key Words Preemptive analgesia  Diclofenac sodium  Intravenous paracetamol  Lornoxicam  Third molar surgery Abstract Objective: The aim of this study was to compare the postop- erative analgesic effects of preoperative intravenous (i.v.) paracetamol, diclofenac sodium and lornoxicam (nonsteroi- dal anti-inflammatory drugs). Subjects and Methods: Sixty patients with impacted third molar who underwent surgical removal were randomly allocated into three groups: group P (n = 20), group D (n = 20) and group L (n = 20). Group P re- ceived preoperatively 1 g paracetamol i.v., group D 75 mg diclofenac sodium i.m. and group L 8 mg lornoxicam i.v. Post- operative pain intensity, additional consumption of analge- sics postoperatively and postoperative complications were compared among groups. Results: The groups were compa- rable for pain scores (p 1 0.05). Maximum pain scores were recorded in postoperative 4th h in all groups (group L 22, 14–44 mm; group P 24, 13–43 mm; group D 14, 10–24 mm, p = 0.117). Patients experienced high satisfaction scores which were comparable among groups (group L 85, 75– 100 mm; group P 87, 70–95 mm; group D 84, 77–98 mm, p = 0.457). Conclusion: Preoperative intramuscular diclofenac, Received: June 7, 2010 Accepted: March 3, 2011 Duygu Yazicioglu Faculty of Dentistry, Ankara University Department of Oral and Maxillofacial Surgery TR–06500 Besevler, Ankara (Turkey) Tel. +90 532 684 3444, E-Mail duyguaytac  @  gmail.com © 2011 S. Karger AG, Basel 1011–7571/11/0205–0470$38.00/0 Accessible online at: www.karger.com/mpp