Intranasal Dexmedetomidine on Post-operative Pain and Swelling after Third Molar Impaction Surgery - A Comparative Study.

Abstract

Introduction: Surgical removal of impacted mandibular third molars often results in post-operative discomfort, including pain, swelling and trismus. Dexmedetomidine, an alpha-2 adrenergic agonist, offers analgesic and sedative benefits with minimal respiratory depression. Its intranasal (IN) use in oral surgery remains underexplored. This study evaluates the efficacy and safety of intranasal dexmedetomidine (IN DEX) in managing post-operative pain, swelling, sedation and haemodynamic parameters in third molar surgery.

Materials and methods: A randomised, double-blind, split-mouth controlled trial was conducted in a tertiary dental teaching hospital. Forty-eight healthy patients aged 18-40 underwent bilateral mandibular third molar extractions across two sessions. One side received IN DEX (1 μg/kg); the contralateral side received a saline placebo. Pain was measured using the Visual Analogue Scale, swelling by five-line facial measurements, sedation by the Modified Observer Assessment of Alertness/Sedation (OAA/S) scale, and haemodynamic parameters were monitored perioperatively.

Results: Data were analysed using paired t-tests and repeated measures ANOVA. P < 0.05 was considered statistically significant. Pain scores were significantly lower with IN DEX at 6, 12 and 24 h (P < 0.001). Peak sedation occurred at 40 min without respiratory compromise. IN DEX caused transient hypotension and bradycardia from 20 to 50 min. Swelling reduction was not statistically significant.

Discussion: IN DEX is a safe, non-invasive adjunct that effectively manages short-term pain and sedation in third molar surgeries, especially in moderate to severe anxiety patients, with stable respiratory function and manageable haemodynamic changes. It may be a promising addition to multimodal analgesic protocols in oral surgery.