The first thing I noted in Dr. Richard Hubbard and colleagues’ November JADA article, "The Analgesic Efficacy of Intramuscular Parecoxib Sodium in Postoperative Dental Pain," was that there was no comparison of parecoxib to an analgesic/anti-inflammatory agent we are all familiar with: ibuprofen. Instead, the article compared intramuscular (IM) parecoxib to IM ketorolac for dental surgical postoperative pain.
The authors state that the two drugs are equal in efficacy for dental postsurgical pain. Both are more effective than placebo. Big deal. This comparison is of little value, except to Pfizer Global Pharmaceuticals, which sponsored the research. All of the researchers, by the way, are either employees of or consultants for Pfizer.
A quick search online showed that 60 milligrams of ketorolac IM was no more effective for emergency room patients in pain than 800 mg of ibuprofen by mouth. This was a double-blind study reported in the Academy of Emergency Medicine.1 Even though 60 mg of ketorolac is double that in the present study, it was no more effective than 800 mg of ibuprofen. It might even be possible that ibuprofen reduces pain more than parecoxib, but we won’t know from this study.
A study in the Journal of Postgraduate Medicine2 concluded that ketorolac is comparable with ibuprofen in analgesic efficacy in 20 postoperative patients and 20 post-laparoscopy patients.
If we are to consider speed of onset of analgesia, it is simple to administer ibuprofen before the procedure for effective analgesia when the local anesthetic wears off. Faster onset than this is unnecessary in most dental procedures.
Both parecoxib and ketorolac are much more expensive than ibuprofen, and much more profitable for their manufacturers, but have no added value for patients in pain, except for those relatively few who are unable to take oral nonsteroidal anti-inflammatory drugs. As dentists, with our patients’ and society’s best interests as our guide, we should prescribe the least expensive medication that will safely provide the best results in a class of drugs. There are very few patients who would benefit from IM parecoxib.
I am surprised that this mostly irrelevant article made it through the review process to be published in JADA. It seems to belong in the new products section instead of the research studies section.
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