Non-steroidal Anti-inflammatories

The proprionic acid derivates (NSAIDs) have both analgesic and antiinflammatory properties. Although salicylates such as aspirin are included in this group, ibuprofen has become the drug of choice for managing dental pain. The dosage is 600 mg every 8 h. Ibuprofen should be taken with food.

Ibuprofen inhibits the enzyme cyclo-oxygenase and thus prevents the conversion of arachidonic acid to prostaglandins, endoperoxidas-es and thromboxanes. Analgesic and anti-inflammatory properties result from peripheral prostaglandin synthesis inhibition.

The use of gastric mucosa protective agents is highly recommended because ibuprofen causes gastrointestinal irritation by interfering with the production of cytoprotective mucus and gastric acid production. It should be avoided in patients with peptic ulcer or a known sensitivity to aspirin; also during the last 3 months of pregnancy because it crosses the placental barrier. Caution is indicated in patients taking oral anticoagulants.

The rationale of pretreatment use of NSAIDs is to block the development of hyperalgesia by reducing the input from peripheral nociceptors, and it is an effective method of reducing postsurgical pain. Because peak serum levels are reached at 1-2 h, a pretreatment dose should be given immediately prior to surgery.