The Analgesic Efficacy of Celecoxib versus Prednisolone for Control of Pain after Periodontal Surgery

Statement of Problem: Postoperative pain after periodontal surgical procedures is a common complaint. Celecoxib, a cyclooxygenase (COX)-2 inhibitor NSAID, is associated with a lower incidence of well known side effects reported for the conventional NSAIDs. Sparse information is available on the efficacy of Celecoxib, or Prednisolone, a steroidal anti-inflammatory drug, following periodontal surgery. The aim of the present study was to compare the analgesic efficacy of Celecoxib and Prednisolone after periodontal mucoperiosteal flap with minor osseous surgery. Methods and Material: In this randomized, double-blind, cross-over, placebo-controlled, clinical trial, 20 patients with generalized, moderate to severe chronic periodontitis underwent three mucoperiosteal flap with minor osseous surgery with at least 4 week interval. Each quadrant was randomly assigned to receive one of the following medications in two doses starting one hour before surgery: 200 mg celecoxib, 10 mg Prednisolone, and placebo. The patients filled out a visual analogue scale (VAS) and a five-point verbal rating scale (VRS-5) at 11 predetermined time periods. Data analyses were performed, using Friedman, Pearson correlation and Spearman rank correlation tests. There was a statistically significant lower pain reported in the celecoxib than placebo groups during 9 postoperative time periods using VAS (p =0.03). This value was statistically significant for all the time periods under investigation, using VRS-5 (p =0.01). The level of pain was lower in Prednisolone than in the placebo groups at the four-hour period (p =0.045), and during the day after surgery (p =0.01). A statistically significant lower pain perception was reported with the use of celecoxib at three postoperative hours (3, 5 and 6) than Prednisolone (p =0.02). There was a positive correlation between VAS and VRS-5 pain rating scales used in this study (p =0.0001, r =0.938). Within the limitations of this study, preventive and postoperative uses of Celecoxib and Prednisolone were effective in the control of pain following periodontal flap with minor osseous surgery. However, during the first 8 postoperative hours, Celecoxib showed a superior efficacy in the duration and continuity of pain relief in comparison with Prednisolone.