Comparative Efficacy of Transdermal Ketoprofen and Diclofenac Sodium in the Management of Post-Endodontic Pain: A Prospective In Vivo Study

Introduction Post-endodontic pain, often resulting from inflammation due to irreversible pulpitis, necessitates the use of effective analgesic strategies. Transdermal nonsteroidal anti-inflammatory drugs (NSAIDs) offer localized pain relief with minimal systemic side effects. This study aimed to compare the efficacy of transdermal ketoprofen and diclofenac sodium in controlling post-endodontic pain and to determine which NSAID provides superior pain relief during the early postoperative period using the Visual Analog Scale (VAS) to assess pain intensity at multiple time points. Materials and methods A prospective, comparative in vivo study was conducted in the Department of Conservative Dentistry and Endodontics at Kalka Dental College, Meerut, India, from June to December 2023. Forty patients (aged 18-55 years) with symptomatic irreversible pulpitis in the premolar teeth were allocated to two groups (n = 20 each) using consecutive sampling: Group 1 received transdermal diclofenac sodium patches (100 mg, Dr. Sabharwal's Wound Care, Delhi, India), and Group 2 received transdermal ketoprofen patches (30 mg, Speedser, Troikaa Pharmaceuticals Ltd., Ahmedabad, India). Following standardized multi-visit endodontic treatment under local anesthesia, pain was assessed using the VAS (0-10 scale) at four, eight, 12, and 24 hours post-treatment. Data normality was confirmed using the Kolmogorov-Smirnov test, and intergroup and intragroup comparisons were analyzed using Mann-Whitney U and Friedman tests, respectively (p < 0.05). Results No significant differences in baseline VAS scores were found between the groups (p = 0.871). Ketoprofen showed significantly lower VAS scores than diclofenac at four hours (2.15 ± 0.03 vs. 2.70 ± 0.03), eight hours (1.25 ± 0.03 vs. 1.89 ± 0.03), 12 hours (0.45 ± 0.01 vs. 0.65 ± 0.02), and 24 hours (0.15 ± 0.01 vs. 0.55 ± 0.02) (p<0.001). No ketoprofen patients required rescue medication, unlike the two patients in the diclofenac group. Both groups showed significant within-group pain reduction (p = 0.001), with ketoprofen having a higher F-value (456.33 vs. 147.92), indicating more pronounced effects. Conclusions Transdermal ketoprofen (30 mg) outperformed diclofenac sodium (100 mg) in the management of post-endodontic pain, offering rapid and sustained relief. These findings support ketoprofen as the preferred analgesic in endodontic practice, highlighting the need for tailored pain management strategies.