Evaluation of analgesic efficacy of transdermal patch versus oral diclofenac tablets in orthodontic patients undergoing multiple premolar extractions - A crossover study

Abstract

Aim: To evaluate and compare analgesic effect of transdermal Diclofenac patch and oral Diclofenac tablet post-orthodontic extraction.

Materials and method: This study was carried out by the Department of Oral and Maxillofacial Surgery, K M Shah Dental College and Hospital. Thirty-two young pre-orthodontic patients requiring bilateral maxillary and mandibular first premolar extractions were selected for the study. The right maxillary and mandibular first premolars were extracted first and 50 mg oral Diclofenac sodium tablets were prescribed to be taken thrice a day for three days. In the next appointment, the contralateral first premolars were extracted and a 100-mg transdermal Diclofenac patch was applied once a day for three days. Pain relief and pain intensity with both the Diclofenac formulations were recorded for each of the three postoperative days using 5-point verbal pain intensity and pain relief score charts. The patients were evaluated on the day of extraction, one day after extraction and two days after extraction.

Results: Statistical analyses revealed that there was a gradual increase in pain relief scores and a gradual decrease in pain intensity scores with the use of oral Diclofenac tablets as well as with the transdermal patch. However, patients reported that they were more comfortable using the transdermal patch particularly due to the once-a-day application and lesser frequency of systemic adverse effects.

Conclusion: Transdermal Diclofenac patch provides as potent analgesia as the oral Diclofenac tablets with the added advantage of better patient compliance and may be used for routine post-extraction analgesia.

Keywords: Diclofenac sodium; orthodontic premolar extraction; transdermal Diclofenac patch.

Figure 1

Armamentarium used for premolar extraction

Figure 2

Oral Diclofenac Tablets

Figure 3

The verbal pain intensity and pain relief score scale

Figure 4

Transdermal Diclofenac patch 100 mg

Figure 5

Design of a matrix-controlled transdermal patch

Figure 6

Transdermal Patch Placed on Right Scapula Region

Figure 7

Transdermal patch placed on left deltoid region

Chart 1

Comparison of pain intensity at different time intervals in the tablet group using chi square test

Chart 2

Comparison of pain relief at different time intervals in the tablet group using chi square test

Chart 3

Comparison of pain intensity at different time intervals in the Transdermal patch group using chi square test

Chart 4

Comparison of pain relief at different time intervals in the Transdermal patch group using chi square test