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Preoperative Use of lntranasal Ketorolac Tromethamine (Sprix) in Periodontal Flap Surgery

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Technical Report

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Uniformed Services University of the Health Sciences Bethesda United States

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Introduction To reduce pain, analgesics intervene at sites of tissue damage, where pain-inducing cytokines are activated. Cytokines stimulate the cyclooxygenase COX pain pathway, causing pain and inflammation. Non-steroidal anti-inflammato1y drngsNSAIDs induce analgesic action by preventing COX2 from being expressed. A 1989Journal of the American Dental Association review recommended preoperative oral ibuprofen administration prior to procedures. However, a 2014 American Academy of Periodontology consensus report on periodontal regeneration indicated future research should focus on pain management strategies. Other NSAIDs, such as ketorolac tromethamine, are delivered rapidly and efficaciously to the bloodstream and may promote more effective analgesia for highly painful periodontal procedures. Objective Dete1mine effect of a single 31.5 mg dose of intranasal ketorolac INKTcompared to placebo given to patients 20 minutes prior to undergoing periodontal flapsurge1y on postoperative analgesic consumption and postoperative pain levels during the initial five postoperative days. Methods A comprehensive literature review using PubMed-MEDLINE identified appropriate studies related to analgesic control before, during, and after periodontalsurge1y. A double-blinded randomized parallel-arm controlled clinical trial was designed.

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