Use of etoricoxib and dexamethasone for postoperative pain prevention and control in mucogingival surgery: a randomized parallel double-blind clinical trial

Ligia Nadal Zardo Fábio André dos Santos Gibson Luiz Pilatti About the authors


AIM: To compare the use of etoricoxib and dexamethasone for postoperative pain prevention and control after mucogingival surgery. METHODS: Fifty-eight patients with indication for mucogingival surgery took part in this randomized parallel double-blind clinical trial. They were divided into three groups (G): G1 - placebo 1 h before surgery; G2 - 8 mg dexamethasone 1 h before surgery; G3 - 90 mg etoricoxib 1 h before surgery. Pain intensity was assessed in donor and recipient sites separately using the 101-point numerical rating scale NRS - 101, every hour for the first 8 h after surgery and three times a day on the following 3 days. RESULTS: there was a statistically significant difference in the postoperative pain intensity in the donor site between G1 and G3 after 1 h, 2 h, 3 h, 7 h, 8 h and on the second day - in the evening after 32 h; between G1 and G2 after 2 h and 3 h, and between G2 and G3 only after the first hour. Pain intensity in the recipient site was statistically significant between G1 and G3 after 1 and 2 h (p<0.05). In addition, there was a lower ingestion of rescue medication in G2 and in G3 than in G1 (p=0.002). CONCLUSIONS: the use of a pre-emptive single dose of etoricoxib or dexamethasone may be considered an effective protocol for postoperative pain prevention and control after mucogingival surgery.

analgesia; pain, postoperative; surgery, oral

  • 1
    Matthews DC, McCulloch CA. Evaluating patient perceptions as short-term outcomes of periodontal treatment: a comparison of surgical and non-surgical therapy. J Periodontol. 1993;64:990-7.
  • 2
    Vogel RI, Desjardins PJ, Major KVO. Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain. J Periodontol. 1992;63:914-918.
  • 3
    American Academy of Periodontology (2001) Glossary of periodontal terms. 4 ed. [cited 2013 Oct 28] Available from:
  • 4
    Bjorn H. Coverage of denuded root surfaces with a lateral sliding flap. Use of free gingival grafts. Odontol Revy. 1971;22:37-44.
  • 5
    Miller PD Jr. Root coverage using the free soft tissue autograft following citric acid application.III. A successful and predictable procedure in areas of deep-wide recession. Int J Periodontics Restorative Dent. 1985;5:14-37.
  • 6
    Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root coverage procedures for the treatment of localized recession-type defects. Cochrane Database Syst Rev. 2009; April15: CD007161.
  • 7
    Kissin I. Pre-emptive Analgesia. Anesthesiology. 2000;93:1138-1143.
  • 8
    Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44:61-98.
  • 9
    Antunes AA, Avelar RL, Martins Neto EC, Frota R, Dias E. Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery. Oral Maxillofac Surg. 2011;15:217-23.
  • 10
    Peres MF, Ribeiro FV, Ruiz KG, Nociti-Jr FH, Sallum EA, Casati MZ. Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery. Braz Dent J. 2012;23:621-8.
  • 11
    Mehlisch DR, Aspley S, Daniels SE, Bandy DP. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clin Ther. 2010;32:882-895.
  • 12
    Steffens JP, Santos FA, Sartori R, Pilatti GL. Pre-emptive Dexamethasone and Etoricoxib for Pain and Discomfort Prevention After Periodontal Surgery: A Double-Masked, Crossover, Controlled Clinical Trial. J Periodontol. 2010;81:1153-1160.
  • 13
    Sotto-Maior BS, Senna PM, de Souza Picorelli Assis NM. Corticosteroids or cyclooxygenase 2-selective inhibitor medication for the management of pain and edema after third-molar surgery. J Craniofac Surg. 2011;22:758-762.
  • 14
    Steffens JP, Santos FA, Pilatti GL. The Use of Etoricoxib and Celecoxib for Pain Prevention After Periodontal Surgery: A Double-Masked, Parallel-Group, Placebo-Controlled Randomized Clinical Trial. J Periodontol. 2011;82:1238-44.
  • 15
    Joshi A, Parara E, Macfarlane TV. A double-blind randomised controlled clinical trial of the effect of preoperative ibuprofen, diclofenac, paracetamol with codeine and placebo tablets for relief of postoperative pain after removal of impacted third molars. Br J Oral Maxillofac Surg. 2004;42:299-306.
  • 16
    Aoki T, Yamaguchi H, Naito H, Shiiki K, Izawa K, Ota Y et al. Premedication with cyclooxygenase-2 inhibitor meloxicam reduced postoperative pain in patients after oral surgery. Int J Oral Maxillofac Surg. 2006;35:613-17.
  • 17
    Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48:961-4.
  • 18
    Al-Sukhun J, Al-Sukhun S, Penttilä H, Ashammakhi N, Al-Sukhun R. Preemptive analgesic effect of low doses of celecoxib is superior to low doses of traditional nonsteroidal anti-inflammatory drugs. J Craniofac Surg. 2012;23:526-9.
  • 19
    Shah R, Mahajan A, Shah N, Dadhania AP. Preemptive analgesia in third molar impaction surgery. Natl J Maxillofac Surg. 2012;3:144-7.
  • 20
    Aznar-Arasa L, Harutunian K, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C. Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial. Int J Oral Maxillofac Surg. 2012;41:1005-9.
  • 21
    Lin S, Levin L, Emodi O, Abu El-Naaj I, Peled M. Etodolac versus dexamethasone effect in reduction of postoperative symptoms following surgical endodontic treatment: a double-blind study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:814-7.
  • 22
    Pilatti GL, Santos FA, Bianchi A, Cavassim R, Tozetto CW. The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery. J Periodontol. 2006;77:1809-1814.
  • 23
    Shi S, Klotz U. Clinical use and pharmacological properties of selective COX-2 inhibitors. Eur J Clin Pharmacol. 2008;64:233-52.
  • 24
    Franchimont D. Overview of the actions of glucocorticoids on the immune response: A good model to characterize new pathways of immunosuppression for new treatment strategies. Ann N Y Acad Sci. 2004;1024:124-137.
  • 25
    Laureano-Filho JR, Maurette PE, Allais M, Cotinho M, Fernandes C. Clinical comparative study of the effectiveness of two dosages of dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med Oral Patol Oral Cir Bucal. 2008;13:129-132.

Publication Dates

  • Publication in this collection
    31 Jan 2014
  • Date of issue
    Dec 2013


  • Received
    12 Aug 2013
  • Accepted
    17 Dec 2013
Faculdade de Odontologia de Piracicaba - UNICAMP Avenida Limeira, 901, cep: 13414-903, Piracicaba - São Paulo / Brasil, Tel: +55 (19) 2106-5200 - Piracicaba - SP - Brazil