Comparing the Efficacy of Preemptive Dexketoprofen Trometamol and Diclofenac Sodium on Post-Operative Sequelae Following Surgical Removal of Mandibular Third Molars

Background and Aims: Surgical removal of mandibular third molars is associated with pain, swelling, and trismus. Although non-steroidal anti-inflammatory drugs (NSAIDs) are widely used, the optimal therapeutic regimen remains unclear. This study aimed to compare the efficacy of preemptive dexketoprofen trometamol and diclofenac sodium on postoperative sequelae following mandibular third molar removal.Method: This prospective, double-blinded, randomized controlled clinical trial involved 110 patients from the Oral and Maxillofacial Surgery Clinic, University of Malaya. Participants were randomly assigned to receive either oral diclofenac sodium 50 mg or dexketoprofen trometamol 25 mg preemptively, followed by three times daily, with paracetamol 1000mg given as a rescue analgesic. The primary outcome was pain intensity during the first six hours following surgery, which was measured using a visual analog scale (VAS). Secondary outcomes included swelling, trismus, and rescue analgesic consumption.Results: The data was analyzed using multivariate analysis, and the significance level was set at p<0.05. Repeated measures one-way analysis of variance, Mann-Whitney U, Friedman, and Wilcoxon signed-rank tests were used where appropriate. There was no significant difference in pain score, swelling, and trismus between the two groups. When combined with paracetamol, diclofenac sodium displayed significantly lower pain scores.Conclusion: Both diclofenac sodium and dexketoprofen trometamol are similarly effective in managing pain, swelling, and trismus. However, diclofenac sodium combined with paracetamol provides superior pain control, supporting a multimodal analgesic approach.