Comparison of the Preemptive Analgesic Efficacy of Submucosal and Trans dermal patch form of Diclofenac and Its Influence on Post–Operative Discomfort in Surgical Removal of Impacted Third Molars -- A Randomized control study

Abstract

Introduction aim and objectives: Diclofenac and other NSAIDs are commonly used for disimpaction in postoperative care, but their efficacy is greater when administered preemptively. Oral diclofenac is associated with risks such as gastrointestinal bleeding and cardiovascular events. Submucosal and transdermal patch formulations have been developed to reduce these risks. This study aims to compare and evaluate the preemptive analgesic efficacy of submucosal and transdermal patch forms of diclofenac in reducing postoperative discomfort in lower third molar surgery, and to assess mouth opening, VAS score, and swelling.
Material and methods : This study recruited 40 patients aged 18 to 30 and randomly divided them into Group S and Group T. Group T received 100 mg transdermal diclofenac patch 10 minutes before surgery, and Group S received 50 mg submucosal diclofenac injection 10 minutes before surgery. Pain, swelling, and mouth opening were measured preoperatively and at 1, 6, and 24 hours postoperatively. Pain was assessed using VAS, and swelling was evaluated using a 3-point scale.
Results: The study findings indicate that administering diclofenac submucosally is more effective in managing postoperative mouth opening and swelling in third molar surgeries. The researchers used a Paired T test to analyze the statistical significance of postoperative swelling and mouth opening in both groups. The results demonstrated a significant difference of 0.02 for preoperative measurements, while the remaining timeline was statistically insignificant. Moreover, a statistically significant difference of 0.03 and 0.02 for 6 and 24 hours was found for postoperative mouth opening in both groups. However, no significant difference was observed for the remaining timeline. In contrast, a statistically significant difference in postoperative pain was observed in both groups for preoperative, 1 hour, and 24-hour groups, with the results being 0.03 and 0.04.

Discussion: The preemptive NSAIDs reducing the post operative pain by inhibiting cyclooxygenases (COX-1, COX-2) which are key in prostaglandin synthesis (Gorecki.et.al), and bypasses first-pass metabolism in the liver (Jenarthanan.et.al). Topical administration of non steroidal anti inflammatory drug offer advantange of local, enhanced drug delivery to affected tissue with lower incidence of local and systemic adverse effects due to reduced plasma concentrations.
Conclusion: To conclude, administering preemptive analgesics in the early stages of surgery is crucial for pain reduction and better results. The submucosal group has a quicker onset but shorter duration of action, with less swelling and better mouth opening than the transdermal patch group. The transdermal patch offers a slow and continuous release of the drug, resulting in prolonged effectiveness and added convenience, making it a promising method for managing pain in the immediate postoperative phase.