Combination paracetamol and ibuprofen for pain relief after oral surgery: a dose ranging study.

PURPOSE: Combined paracetamol and ibuprofen has been shown to be more effective than either constituent alone for acute pain in adults, but the dose-response has not been confirmed. The aim of this study was to define the analgesic dose-response relationship of different potential doses of a fixed dose combination containing paracetamol and ibuprofen after third molar surgery. METHODS: Patients aged 16 to 60 years with moderate or severe pain after the removal of at least two impacted third molars were randomised to receive double-blind study medication as two tablets every 6 h for 24 h of either of the following: two tablet, combination full dose (paracetamol 1000 mg and ibuprofen 300 mg); one tablet, combination half dose (paracetamol 500 mg and ibuprofen 150 mg); half a tablet, combination quarter dose (paracetamol 250 mg and ibuprofen 75 mg); or placebo. The primary outcome measure was the time-adjusted summed pain intensity difference over 24 h (SPID 24) calculated from the 100-mm VAS assessments collected over multiple time points for the study duration. RESULTS: Data from 159 patients were included in the analysis. Mean (SD) time-adjusted SPID over 24 h were full-dose combination 20.1 (18.0), half dose combination 20.4 (20.8), quarter dose combination 19.3 (20.0) and placebo 6.6 (19.8). There was a significant overall effect of dose (p = 0.002) on the primary outcome. Planned pairwise comparisons showed that all combination dose groups were superior to placebo (full dose vs. placebo p = 0.004, half dose vs. placebo p = 0.002, quarter dose vs. placebo p = 0.002). The overall effect of dose was also significant for maximum VAS pain intensity score (p = 0.048), response rate (p = 0.0094), percentage of participants requiring rescue (p = 0.025) and amount of rescue (p < 0.001). No significant dose effect was found for time to peak reduction in VAS or time to meaningful pain relief. The majority of adverse events recorded were of mild (52.75%) or moderate (40.16%) severity and not related (30.7%) or unlikely related (57.5%) to the study medication. CONCLUSION: All doses of the combination provide safe superior pain relief to placebo in adult patients following third molar removal surgery.

Maxillofacial fractures sustained by unmounted equestrians.

Facial injuries caused by horses are relatively common among riding enthusiasts, but little is known about the nature of maxillofacial fractures sustained by those not mounted. We collected data on patients' characteristics, fractures sites, mechanisms of injury, and treatment of these fractures from the departmental records of the oral and maxillofacial unit at Christchurch Hospital, New Zealand between 1996 and 2008. Of 49 patients with equine-related facial fractures, 35 (mean (SD) age 35.8 (16.7) years) had sustained their injuries while unmounted (71%). Most of the fractures occurred in women (66%), of whom 39% were aged between 16 and 30 years. There was an increasing trend in the incidence of these fractures over much of the 13-year period. Most injuries were caused by kicks (69%), followed by head-butts (26%), and trampling (6%). The zygoma was the most common fracture site (63%), followed by the mandible (34%), and orbital floor (31%). Surgical intervention was required in 60% of cases.

Comparison between interpersonal violence and motor vehicle accidents in the aetiology of maxillofacial fractures.

BACKGROUND: Maxillofacial fractures commonly present to the emergency department, interpersonal violence (IPV) and motor vehicle accidents (MVA) being two of the main causes. There is a changing trend in these two aetiologies, which is reflected in a change in demographics, the pattern of fractures and the treatment of maxillofacial fractures. METHODS: A prospective database of patients presenting to the Oral and Maxillofacial Surgery service at Christchurch Hospital during an 11-year period was reviewed. Of a total of 2581 patients with radiographic confirmation of facial fractures, 1135 patients sustained injuries following IPV and 286 patients following MVA. Variables examined include demographics, type of fracture, mode of injury, and treatment. RESULTS: The male:female ratio was 9:1 in patients following IPV and 7:3 following MVA; 16-30-year-olds accounted for greatest proportion of injuries (48 and 68%, respectively). There was alcohol involvement in 87% of fractures caused by IPV, compared with 58% for MVA. Mid-facial fractures were more frequently seen in MVA, whereas mandibular fractures were more prevalent in IPV. Sixty-two per cent of the patients from MVA required active treatment and 87% were hospitalized, compared with 56% actively treated and 59% hospitalized in the IPV group. CONCLUSION: Interpersonal violence has continued to be the main cause of maxillofacial fractures. Both IPV and MVA commonly involve alcohol and young male adults. They frequently require hospitalization and surgical intervention.