Evaluation of a long-acting local anesthetic (Bupivacaine) and a selective COX-2 inhibitor (Rofecoxib) in suppression of central sensitization
Chuang, Brian Po-Jen
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Pain of odontogenic origin results from direct activation of nociceptive afferent nerve fibers and the actions of inflammatory mediators. A positive feedback loop, caused by the interaction of inflammatory mediators such as prostaglandins, prolongs inflammation and pain beyond cessation of nociceptive input from the site of injury. Central mechanisms are activated by both nociceptive barrage during tissue injury and postoperative inflammation to produce hyperalgesia hours to days after the initiating events while both surgical nociceptive input and inflammation contribute to central sensitization. Their respective contributions have not been clearly evaluated. The purpose of this study was to assess their relative impact using an oral surgery model and intervention to selectively attenuate postoperative nociceptive barrage or inflammation. In this randomized, double-blind controlled clinical trial, subjects were allocated to receive either 2% lidocaine or 0.5% bupivacaine (both with 1:200,000 epinephrine) as local anesthetic to manage perioperative pain. Subsequently, subjects were provided either placebo or the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib 50 mg QD to manage inflammation in a two by two factorial design resulting in 4 groups: lidocaine/placebo, lidocaine/rofecoxib, bupivacaine/placebo, and bupivacaine/rofecoxib. Conscious sedation was induced with midazolam and bilateral impacted mandibular third molars were extracted. Pain was assessed over the first 4 hours and then at 24 and 48 hours after surgery. Microdialysis samples were collected from the surgical site over the immediate postoperative period, and subsequently analyzed with an enzyme immunoassay to demonstrate the level of inflammatory mediators: a product of COX-1, ... [TRUNCATED]
PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact email@example.com.Thesis (MSD)--Boston University, Henry M. Goldman School of Dental Medicine, 2005 (Endodontics).Includes bibliography: leaves 60-66.
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