Preoperative Use of Intranasal Keto Ro Lac Tromethamine (sprix®) in Period Ont Al Flap Surgery

PREOPERATIVE USE OF INTRANASAL KETOROLAC TROMETHAMINE (SPRIX®) IN PERIODONTAL FLAP SURGERY STEPHEN B. HUTTON, DMD, MPH PERIODONTICS DEPARTMENT, 2015 Thesis directed by: Peter M. Bertrand, DDS CAPT (Ret), DC, USN Naval Postgraduate Dental School Introduction: To reduce pain, analgesics intervene at sites of tissue damage, where paininducing cytokines are activated. Cytokines stimulate the cyclooxygenase (COX) pain pathway, causing pain and inflammation. Non-steroidal anti-inflammato1y drngs (NSAIDs) induce analgesic action by preventing COX2 from being expressed. A 1989 Journal 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 (INKT) compared to placebo given to patients 20 minutes prior to undergoing periodontal flap surge1y 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 periodontal surge1y. A double-blinded randomized parallel-arm controlled clinical trial was designed. Results: Several options to perform preoperative analgesic management exist. Wellcontrolled, experimental evidence demonstrates post-operative pain levels and rescue drng consumption arc reduced in patients managed with pre-operative NSAIDs. Yet, few studies have evaluated the use of INKT as an adjunct to pain control in the dental setting. Following design of the clinical trial in concert with Roxro phannaceuticals, Roxro was acquired and the new parent company discontinued active promotion of SPRIX® (INKT) and sponsorship of clinical trials. The study was discontinued. Conclusions: Preoperative analgesic administration may minimize pain and postoperative analgesic consumption. However, dental research has yet to evaluate in highly painful procedures, such as quadrant periodontal flap surgery, the effect of preoperative administration ofINKT on postoperative dental pain levels and postoperative analgesic consumption.