Pain after surgery: can protective analgesia reduce pain? A randomised clinical trial

To improve the patients postoperative pain experience using protective analgesia for patients undergoing third molar surgery under day case general anaesthesia.

Patients were randomly allocated to a protective analgesia (1.6g modified release ibuprofen) or conventional analgesia (400mg conventional ibuprofen) orally 2h preoperatively. Surgical model was third molar surgery. Postoperative outcomes of interest were pain intensity at 30 min, 1, 6, 24 and 48 h. The time to rescue analgesia, overall assessment of pain control, safety and tolerability profiles were also recorded.

122 patients entered the study providing 98 evaluable patients for analysis. Patients in the protective analgesia group reported more pain than those in the conventional group at 30 min, 1, 6 and 48 h following surgery, although this difference was only statistically significant at the 30 min time point. 62.2% of patients required rescue analgesia within 6h after surgery. The median time for patients who had to take rescue analgesia was 3.1h. Patients in the protective analgesia group reported a longer time to rescue analgesia compared with those in conventional analgesia group. Overall, 91.7% of patients were at least satisfied with their pain control.

There was no difference in the protective analgesia group compared with conventional analgesia group in improving postoperative pain experience. A different protective analgesia regime may be necessary, which employs a more aggressive and multimodal strategy for postoperative pain management.