Intramuscular diclofenac sodium after free gingival graft surgery: does the initial route matter? A prospective observational study

Early postoperative pain after free gingival graft (FGG) surgery could be difficult to control, and many patients need frequent analgesic use during the first week. When pain control is inadequate, both comfort and daily functioning may be negatively affected. This prospective observational study evaluated whether the initial route of diclofenac sodium administration was associated with early postoperative discomfort after FGG. Participants were grouped into the test group ( n = 15), who received the initial postoperative diclofenac sodium dose by intramuscular (IM) injection, and control group ( n = 15), who received the initial postoperative diclofenac sodium dose orally. In both groups, the initial dose was administered before the effect of local anesthesia had resolved. Additional oral diclofenac sodium and paracetamol intake was then recorded as rescue analgesic use. Outcomes included numeric rating scale (NRS) pain scores, analgesic consumption, and patient-reported outcome measures (PROMs). Statistical significance was set at p < 0.05. NRS scores were significantly higher in the control group on the day of surgery and during the following 4 postoperative days ( p < 0.05 for all). Additional oral diclofenac sodium intake was significantly higher in the control group on the day of surgery, on postoperative day 3, and in total cumulative usage. Paracetamol consumption was significantly higher in the control group on the day of surgery, following 2 days, and in total cumulative usage. The test group reported significantly better daily activity performance, sleep, and work or school attendance, as well as greater ease in eating and drinking, across the day of surgery and following 2 days ( p < 0.05 for all). No significant between group differences were observed for swelling ( p > 0.05). In this prospective observational study, the initial postoperative intramuscular route of diclofenac sodium administration was associated with lower early postoperative pain scores, lower subsequent oral rescue analgesic consumption, and more favorable patient-reported outcomes after FGG surgery. ClinicalTrials.gov, NCT06675734. Registered 4 November 2024, retrospectively registered.