COMBINATION OF DICLOFENAC WITH PARACETAMOL OFFER BETTER PAIN RELIEF THAN IBUPROFEN ALONE IN IMPACTED THIRD MOLAR EXTRACTION: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND: Combination of non-steroidal anti-inflammatory drugs (NSAIDs) with paracetamol for management of acute postoperative pain is widely used in clinical practice, but therapeutic superiority of such combination over NSAID alone remains controversial. The aim of this study was to evaluate whether the combination of diclofenac 50mg and paracetamol 500mg (Dynapar tablet) twice daily regime offer superior analgesia than thrice daily regime of Ibuprofen 400mg tablet in management of dental pain following impacted third molar extraction. MATERIALS AND METHODS: 150 postoperative patients were randomized to receive either treatment for four days. Primary efficacy endpoints were time to onset of analgesia, time to maximum pain relief and pain relief at 8 hrs while secondary efficacy endpoints included improvement in pain intensity at 8 hours, pain relief scores at 24, 48 hours and on day 4, global assessment by patients and investigator; rescue analgesia requirement. RESULTS AND DISCUSSION: Dynapar tablet offers significantly better improvement in postoperative pain intensity (3.00 ± 2.29 versus 2.067 ± 2.12, P=0.0025) and pain relief (2.58 ± 0.92 versus 2.06 ± 0.92, P < 0.0001) than Ibuprofen at 8 hour. Pain relief at 24 (P < 0.0001), 48 hours (P < 0.0001) and on day 4 (P = 0.0001) in Dynapar group was significantly higher than Ibuprofen. Also, global assessment of investigators and patients were significantly more favourable towards Dynapar tablet. No statistically significant differences were found in other efficacy endpoints. CONCLUSION: Dynapar tablet offers superior analgesia compared to ibuprofen in management of acute postoperative pain following impacted third molar extraction