Controle da dor pós-operatória em odontologia com cetorolaco de trometamol / Control of postoperative pain in dentistry with ketorolac of trometamol

O controle da dor e da inflamação pós-operatória são constantes preocupações dos cirurgiões, bem como o bem-estar do paciente após o ato cirúrgico, esses fatores estão intimamente ligados ao sucesso dos procedimentos e técnicas aplicadas. O cetorolaco é um anti-inflamatório não esteroidal (AINE) não seletivo, que age indistintamente sobre as cicloxigenases 1 e 2 e está indicado no tratamento da dor pós-operatória ou processos dolorosos de intensidade moderada a grave. Esta revisão de literatura se propôs a elucidar os efeitos analgésicos e anti-inflamatórios do cetorolaco de trometamol aplicado tanto de forma preventiva quanto pre-emptiva no tratamento da dor, bem como suas reações adversas, apresentando vantagens e desvantagens deste fármaco. Diante da revisão de literatura abordada, os autores concluíram que: a analgesia pre-emptiva deve ser feita sempre que possível; o cetorolaco de trometamol apresenta maior eficácia analgésica que os opióides, porém, deve ser usado em curto prazo, pelo risco de desenvolver doenças gastrointestinais, além do cuidado da sua indicação que segue as recomendações comuns a todos os AINES empregados em odontologia.

The pain control and postoperatory inflammation are constant concerns of surgeons, as well as the welfare of the patient after surgery, these factors are closely linked to the success of the procedures and techniques. Ketorolac is a non steroid anti-inflammatory drug (NSAID) non-selective, which acts indiscriminately on cyclooxygenase 1 and 2 and is indicated for the treatment of postoperative pain or painful processes of moderate to severe intensity. This literature review aimed to elucidate the analgesic and anti- inflammatory ketorolac trometamol applied as a preventive and preemptive treatment of pain and its adverse reactions, presenting advantages and disadvantages of this drug. Given the literature review addressed, the authors concluded that: preemptive analgesia should be performed whenever possible; ketorolac trometamol shows greater efficacy than opioids, however, should be used in short term, at risk of developing gastrointestinal diseases, beyond the care of his statement following the recommendations common to all NSAIDs used in dentistry.

Treatment with paracetamol, ketorolac or etoricoxib did not hinder alveolar bone healing: a histometric study in rats

Prostaglandins control osteoblastic and osteoclastic function under physiological or pathological conditions and are important modulators of the bone healing process. The non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) activity and consequently prostaglandins synthesis. Experimental and clinical evidence has indicated a risk for reparative bone formation related to the use of non-selective (COX-1 and COX-2) and COX-2 selective NSAIDs. Ketorolac is a non-selective NSAID which, at low doses, has a preferential COX-1 inhibitory effect and etoricoxib is a new selective COX-2 inhibitor. Although literature data have suggested that ketorolac can interfere negatively with long bone fracture healing, there seems to be no study associating etoricoxib with reparative bone formation. Paracetamol/acetaminophen, one of the first choices for pain control in clinical dentistry, has been considered a weak anti-inflammatory drug, although supposedly capable of inhibiting COX-2 activity in inflammatory sites. OBJECTIVE: The purpose of the present study was to investigate whether paracetamol, ketorolac and etoricoxib can hinder alveolar bone formation, taking the filling of rat extraction socket with newly formed bone as experimental model. MATERIAL AND METHODS: The degree of new bone formation inside the alveolar socket was estimated two weeks after tooth extraction by a differential point-counting method, using an optical microscopy with a digital camera for image capture and histometry software. Differences between groups were analyzed by ANOVA after confirming a normal distribution of sample data. RESULTS AND CONCLUSIONS: Histometric results confirmed that none of the tested drugs had a detrimental effect in the volume fraction of bone trabeculae formed inside the alveolar socket.

Intrathecal ketorolac injection in albino rats; pharmacological and histological study

Ketorolac tromethamine is a potent injectable non-steroidal anti-inflammatory drug [NSAID]. Ketorolac provides successful analgesia after intrathecal or epidural injection. It is frequently used to manage post-operative pain, cancer pain, and arthritis either intrathecally, or intramuscular. However, its long term administration could induce renal toxicity and/or gastro-intestinal ulceration. The aim of this study was to assess the analgesic potency of ketorolac after intrathecal injection. Also, we aimed to study the histological effect of ketorolac on the spinal cord and the duodenum after treatment in an animal model. 40 adult male albino rats, weighing 250-350 gm, were used and divided into 4 groups, 10 rats each. Group S [control] received 10 microl normal saline intrathecally, group K50 received 50microg ketorolac intrathecally, group K50 + omeprazole [proton pump inhibitor] received 50microg ketorolac intrathecally plus 0.2 mg omeprazole orally, and finally, group K100 received 100microg ketorolac intrathecally. All animals were treated for four successive days. The rat tail flick latency was longer in K50, K50 + omeprazole, and K100 groups when compared to normal control [P = 0.002]. Also, the hind-paw withdrawal latency was longer in treated groups when compared to those of the control group [P = 0.0001]. Moreover, K50 group showed decreased phase II response by 61%, K50 + omeprazole group showed decreased phase II by 62%, while K100 group showed decreased it by 76%. Histological examination revealed no changes in the spinal cord of all treated animals. Also, examination of the duodenum showed normal duodenal mucosa in group K50 and those of group K50 + omeprazole. On the other hand, cellular infiltration as well as destruction of the mucous acini have been noticed in the duodenum of K100 group. Ketorolac could be a good alternative drug used intrathecally to manage pain