Comparison of the analgesic effect of a corticosteroid and paracetamol in patients with pain after oral surgery.

In a double-blind crossover study identical oral surgical procedures were performed on two separate occasions in 24 patients. After one operation they were given capsules of methylprednisolone. A total of 84 mg was administered in decreasing doses for 4 days, starting with 24 mg 2 h after surgery. After the other operation 1 g paracetamol was given at 2, 6 and 9 h after surgery, then 500 mg four times daily for the next 2 days. Several measurements/assessments were recorded for paired comparisons of the postoperative courses. There was no significant difference in pain scores when comparing the two treatments. However, 3 and 4 h after the operation, there was a tendency towards better pain relief with paracetamol (P greater than 0.05). The results suggest that methylprednisolone, after a delay, may exert analgesic efficacy comparable to a standard regimen with paracetamol. On the third postoperative day methylprednisolone reduced measured swelling by 29% compared to paracetamol (P = 0.03). Overall preference scores evaluated the two treatments as equally efficient on the day of surgery. The first and second postoperative day the scores were in favour of methylprednisolone (P = 0.03). Present and previous results in this model suggest that corticosteroids deserve attention as a means of reducing both pain and inflammation after surgery and trauma.