Comparison between lysine and paracetamol for post tooth extraction pain control

Abstracts

JUSTIFICATIVA E OBJETIVOS: A exodontia é praticada desde os primórdios da humanidade como forma de resolver cirurgicamente os problemas dentários. Porém, como todo procedimento cirúrgico, ela promove um processo inflamatório reacional que se apresenta clinicamente com dor. Muitos fármacos têm sido usados no intuito de minimizar o desconforto pós-operatório, porém um protocolo para o seu controle ainda não está estabelecido. Este estudo teve como objetivo avaliar o efeito analgésico do clonixinato de lisina e paracetamol no controle de dor pós-exodontia. MÉTODO: Estudo duplamente encoberto e randomizado com 40 pacientes atendidos no Ambulatório de Cirurgia I no Departamento de Odontologia da Universidade Federal de Sergipe (DOD/UFS) que necessitaram de extrações por via alveolar em hemiarcadas diferentes utilizando clonixinato de lisina (125 mg) três vezes ao dia ou paracetamol (750 mg) quatro vezes ao dia, ambos por três dias no pós-operatório. A dor foi avaliada nas primeiras 24 e 48h com o uso da escala analógica visual. Os dados foram submetidos aos testes estatísticos t de Student e de Friedman. RESULTADOS: Não houve diferenças estatisticamente significantes entre idade, em relação aos gêneros e em relação à intensidade da dor. CONCLUSÃO: Tanto o clonixinato de lisina como o paracetamol foi eficaz para o controle da dor pós-exodontia.

Dor; Exodontia; Lisina; Paracetamol

ORIGINAL ARTICLE

Comparison between lysine and paracetamol for post tooth extraction pain control^*

Klinger de Souza Amorim^I; Lucas Celestino Guerzet Ayres^I; Rafael Soares da Cunha^I; Liane Maciel de Almeida Souza^II; Mônica Silveira Paixao^III; Francisco Groppo^IV

^IStudent of Dentistry, Federal University of Sergipe (UFS). Aracaju, SE, Brazil

^IIAssociate Professor of Anesthesiology and Surgery I, Federal University of Sergipe (UFS). Doctor in Implantodontics, São Leopoldo Mandic. Aracaju, SE, Brazil

^IIIAssistant Professor of Legal Dentistry, Federal University of Sergipe. Doctor in Biotechnology, RENORBIO. Aracaju, SE, Brazil

^IVProfessor of the Dentistry School, Piracicaba (FOP/UNICAMP). Doctor in Pharmacology, Anesthesiology and Drug Therapy (FOP/UNICAMP). Campinas, SP, Brazil

^{Correspondence to}

SUMMARY

BACKGROUND AND OBJECTIVES: Tooth extraction is practiced since the early days of mankind to surgically solve dental problems. However, as any surgical procedure, it promotes an inflammatory reaction with clinical presentation of pain. Several drugs have been used to minimize postoperative discomfort; however there is still no established protocol for its control. This study aimed at evaluating the analgesic effect of lysine and paracetamol to control post tooth extraction pain.

METHOD: Double blind randomized study with 40 patients seen by the Surgical Outpatient Setting I, Dentistry Department, Federal University of Sergipe (DOD/UFS), who needed alveolar extractions in different hemiarcades using lysine (125 mg) three times a day or paracetamol (750 mg) four times a day, both during three postoperative days. Pain was evaluated at 24 and 48 hours with the visual analog scale. Data were submitted to Student's t and Friedman statistical tests.

RESULTS: There have been no statistically significant differences in age, gender and pain intensity.

CONCLUSION: Both lysine and paracetamol were effective to control post tooth extraction pain.

Keywords: Lysine, Pain, Paracetamol, Tooth extraction.

INTRODUCTION

Tooth extraction is practiced since the early days of mankind to surgically solve dental problems. However, as any surgical procedure, it promotes an inflammatory reaction with clinical presentation of pain.

Postoperative pain control in Dentistry should be induced before the surgical procedure, since many studies suggest the prescription of steroid or non-steroid anti-inflammatory drugs or of analgesics with some anti-inflammatory property.

Many drugs have been used to minimize postoperative discomfort. Some protocols include medication after surgery. The best moment for its effective use is still not totally explained².

Paracetamol is a very important non-opioid analgesic, in general prescribed for the post tooth extraction period. The dose of 1000 mg of paracetamol induces efficient analgesia after oral surgeries. Adequate plasma concentration level is established 90 minutes after oral administration. It should be prescribed in the dose of 60 to 90 mg/kg every six hours².

Lysine is an anti-inflammatory analgesic of the carboxylic acids group, characterized by strong central and peripheral analgesic power and low anti-inflammatory action³. It acts by reversibly inhibiting cyclooxygenase, blocking prostaglandin synthesis and antagonizing prostaglandins³.

A study comparing lysine and paracetamol for oral postoperative pain has not shown significant differences between drugs⁴. In animals, lysine showed 3-hour half-life being a short-life non-steroid anti-inflammatory drug (NSAID) as compared to other drugs of its category⁵.

Orally administered, lysine has excellent biological tolerance and low incidence of side effects in the treatment of painful syndromes, such as renal pain, neurogenic pain, muscle pain, tooth pain^6,7 and migraine⁸.

Considering the scarcity of studies with this drug in Dentistry, our study aimed at evaluating and comparing the analgesic effect of both drugs.

METHOD

This was an experimental, double-blind, crossover and randomized study including 40 patients admitted to the Surgery I Ambulatory, Department of Dentistry, Federal University of Sergipe (DOD/UFS) from May 2011 to May 2012, submitted to alveolar extractions in different hemiarcades.

Every patient was individually approached to explain the importance of the research. Inclusion criteria were individuals of both genders, aged between 18 and 60 years, who signed the Free and Informed Consent Term. Exclusion criteria were individuals below 18 and above 60 years of age, patients with active peptic ulcer or digestive hemorrhage, infants or those allergic to paracetamol or lysine.

Patients were referred to the first investigator who delivered them a bottle with the medication A (125 mg lysine) or B (750 mg paracetamol). These drugs were manipulated in the pharmacy so that patients and remaining investigators could not identify them.

Then, patients were referred to the surgeon (second investigator) who performed the extractions according to the protocol⁹. All patients were anesthetized with 2% lidocaine with 1:100000 epinephrine, not exceeding two tubets¹⁰. After extraction, patients received all information about postoperative care and were oriented to return 24 hours later to the DOD.

After 24 hours, the third investigator has evaluated the analgesic efficacy of the drug by the 10-cm visual analog scale (VAS) were zero means no pain and 10 unbearable pain. Patients were oriented to return 48 hours later for a new pain intensity evaluation. Eight days after the first procedure, patients returned for stitch removal and for another tooth extraction with another drug to be observed (A or B), as the case might be.

After collection, data were tabulated and submitted to statistical Student's t and Friedman's tests with p < 0.05.

This study was approved by the Ethics and Research Committee, Federal University of Sergipe (UFS), protocol CAAE 0263.0.000.107-2011.

RESULTS

From 40 included patients, 12 were males and 28 females. There have been no statistically significant differences (t test, p = 0.2176) in age between females (3.51 ± 13.8 years) and males (41.3 ± 15 years).

Pain intensity by Friedman 's test has not shown statistically significant difference (p > 0.05) between drugs and between periods.

Graph 1 show that patients' pain was mild when considering pain classification as mild, moderate and severe by VAS values in cm¹¹.

DISCUSSION

As described in the literature¹², difference in gender was not statistically significant for post alveolar tooth extraction pain. Differently from another study¹³, this has not shown statistically significant differences in pain with regard to patients' age.

Most common VAS for postoperative pain evaluation is a 100 mm long line representing the continuum of the pain experience. Its edges have the anchor words no pain and worst possible pain. Participants are oriented to mark their pain intensity on a point of this line and scores may vary from zero to 10. Scores are obtained by measuring, in millimeters, the distance between the edge anchored by the words no pain and the point marked by the participant. This scale has the advantage of being easy to apply¹⁴. Pain evaluation by VAS is well accepted, including to evaluate postoperative patients' pain¹⁵. Our study has used VAS without pre-existing marks to prevent any type of bias when patients marked their pain intensity.

Our results have not shown statistically significant differences between paracetamol and lysine to control post alveolar tooth extraction pain³. Lysine action on the central nervous system is suggested by the presence of major analgesic effect, similar to opioids. Strong central nociceptive action does not depend on the presence of inflammatory or hyperalgic process, which is still not totally explained. It seems that there is interaction of lysine with central opioid receptors, although the action mediated by such receptors has not been evidenced¹⁶. This study has shown good analgesic action of this drug, which is confirmed by the presence of mild pain only¹¹.

Different from other findings¹⁷ pain intensity was not statistically significant 24 or 48 hours after surgery. Similarly to previous studies¹⁸, patients receiving lysine did not report undesirable effects, showing the good tolerability of the drug.

CONCLUSION

Both lysine and paracetamol were effective to control post tooth extraction pain. Lysine may be considered a good option for patients who cannot use other analgesic drugs.

REFERENCES

Submitted in August 07, 2012.

Accepted for publication in November 14, 2012.

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*

Received from the Dentistry Department, Federal University of Sergipe (UFS). Aracaju, SE.

Publication Dates

• Publication in this collection
  08 Jan 2013
• Date of issue
  Dec 2012

History

• Received
  07 Aug 2012
• Accepted
  14 Nov 2012