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. 2015 Jun;14(2):219-25.
doi: 10.1007/s12663-013-0609-1. Epub 2014 Feb 18.

A prospective study to assess the levels of interleukin-6 following administration of diclofenac, ketorolac and tramadol after surgical removal of lower third molars

Puneet Singh  1 , Sanjay Rastogi  2 , Mansi Bansal  3 , Sanjeev Kumar  2 , Rakesh Singh  4 , Sumita G Nishad  5 , Mahendra P Reddy  2 , Kumar Rakshak Anand  2 , Saurabh Kumar  1 , Muhamad Nishad Thayath  5
Affiliations

A prospective study to assess the levels of interleukin-6 following administration of diclofenac, ketorolac and tramadol after surgical removal of lower third molars

Puneet Singh et al. J Maxillofac Oral Surg. 2015 Jun.

Abstract

Introduction: The surgical removal of impacted third molars involves, trauma to soft and bony tissue and can result in considerable pain, swelling, and trismus. The greater the amount of tissue injury the greater is the amount of inflammation in the perisurgical region. Interleukin-6 (IL-6) is both a pro inflammatory and anti-inflammatory cytokine. It is secreted by T cells and macrophages to stimulate the immune response. IL-6 is also an early marker of tissue damage. In addition to NSAIDs, corticosteroids, opioids also have immunomodulatory effects.

Aim: To evaluate the changes in serum IL-6 levels following surgical removal of third molars under local anaesthesia after administration of two NSAIDs diclofenac and ketorolac and opioid tramadol post operatively.

Methods: Patients undergoing surgical removal of impacted mandibular third molar teeth were randomly assigned to three groups. Each group received one of the three analgesics viz diclofenac 50 mg, ketorolac 10 mg and tramadol 50 mg. The mean levels of IL-6 was then estimated by ELISA.

Results: The results of our study showed that all three drugs i.e. diclofenac, ketorolac and tramadol have properties which can downregulate the production of IL-6 in response to surgical trauma.

Conclusion: It is of clinical significance that the suppression of IL-6 values occurs in tramadol group closely following the diclofenac group. Even though the drug ketorolac suppresses the IL-6 levels similar to diclofenac initially but after 7 days tramadol and ketorolac showed similarities in suppression of IL-6 expression which is less compared to diclofenac group.

Keywords: Diclofenac; Interleukin-6; Ketorolac; Third molar surgery; Tramadol.

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Figures

Graph 1
Graph 1
Depicts the similarity of diclofenac and ketorolac on IL-6 concentrations during all 4 time periods
See this image and copyright information in PMC

References

    1. Cruickshank AM, et al. Serum interleukin 6 (IL-6) - effect of surgery and under-nutrition. Clini Nutr. 1991;10(Supp):65–69. doi: 10.1016/0261-5614(91)90118-V. - DOI - PubMed
    1. Mahdy AM, et al. Differential modulation of interleukin-6 and interleukin-10 by diclofenac in patients undergoing major surgery. Br J Anaesth. 2002;88(6):797–802. doi: 10.1093/bja/88.6.797. - DOI - PubMed
    1. Kim MH et al (2001) Plasma levels of interleukin-6 and interleukin-10 are affected by ketorolac as an adjunct to patient-controlled morphine after abdominal hysterectomy. Clin J Pain 17:72–77 - PubMed
    1. El-Sharrwy EA, et al. Attenuation of C-reactive protein increases after exodontia by tramadol and ibuprofen. Anesth Prog. 2006;53:78–82. doi: 10.2344/0003-3006(2006)53[78:AOCPIA]2.0.CO;2. - DOI - PMC - PubMed
    1. Mishra H, Khan FA. A double-blind, placebo-controlled randomized comparison of pre and postoperative administration of ketorolac and tramadol for dental extraction pain. J Anaesthesiol Clin Pharmacol. 2012;28(2):221–225. doi: 10.4103/0970-9185.94892. - DOI - PMC - PubMed