Use of Intravenous Acetaminophen in Postoperative Pain Management After Partial and Full Bony Impacted Third Molar Extractions: A Randomized Double-Blind Controlled Trial.

PURPOSE: Currently, there is a concern at the national level of the overuse of both prescription and nonprescription opioid use. The purpose of this study was to identify whether the use of the intravenous (IV) formulation of acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom) is an effective tool in the reduction of postoperative pain, with a secondary goal of reduction of postoperative narcotic use. MATERIALS AND METHODS: A total of 72 patients with previously diagnosed either partial bony or complete bony impacted third molars were selected with care to avoid long-acting local anesthetics or dissociative anesthetic agents. The patients' postoperative pain scores at 4 and 24 hours were collected via a verbal rating scale by the primary investigator. The exclusion criteria included administration of bupivacaine or ketamine, hepatic or renal impairment, pregnancy, or allergy to any of the normally administered sedation medications. RESULTS: At all postoperative increments (immediately, 4 hours, and 24 hours), there was no significant difference at P < .05 between scores for either the IV acetaminophen or placebo group. Although there was a recorded difference in reduction of pain at both 4 and 24 hours postoperatively, these were not statistically significant variables. CONCLUSIONS: The use of IV acetaminophen showed no statistically significant decrease in patient pain at either 4 or 24 hours postoperatively. Although there are not representative data suggesting the routine use of IV acetaminophen, on the basis of the abundance of literature on the treatment of pain for other procedures, this medication should not be discarded as ineffective.

Anatomic study of the distance between the articular eminence and foramen spinosum and foramen spinosum and petrotympanic fissure.

PURPOSE: The middle meningeal artery is in close proximity to the medial aspect of the temporomandibular joint (TMJ). A major potential complication of surgery in the area of the TMJ is possible severance of the middle meningeal artery. An understanding of the relationship of the middle meningeal artery to easily identifiable landmarks lateral to the TMJ can help prevent the complications associated with TMJ surgery. The aim of the present study was to define the location of the middle meningeal artery by relating the distance between the easily identifiable bony landmarks of the articular eminence, petrotympanic fissure, and foramen spinosum. MATERIALS AND METHODS: Using a cross-sectional study design, we selected dried skulls from the Hamman-Todd skeleton collection at the Cleveland Museum of Natural History that were older than 20 years of age at death. The primary study variables were the distances between the articular eminence and foramen spinosum and the foramen spinosum and petrotympanic fissure. To appropriately analyze the variables, stratifications of age, gender, race, and anatomic location were applied. To measure the relationship between the stratifications and distances, a multivariate analysis of variance test was performed. The statistical results were deemed significant at P < .05. RESULTS: The sample consisted of 354 skulls or a total of 708 complexes. In analyzing the data, we noted that the only stratifications that bore any statistical significance were gender, with P < .0001, and the race-distance correlation, with a P value of .0007. CONCLUSIONS: The results of the present study suggest a definite difference in regard to gender on the distance between both sets of anatomic landmarks. Future studies could be tailored to further explore the effect of age on the distance, as a slight correlation was noted in our study.