# The Use of Ibuprofen Arginate in Pain Management Following Third Molar Surgery--A Scoping Review
## 4 Discussion  
The present scoping review highlights findings regarding the use of ibuprofen arginate for managing postoperative inflammatory sequelae following third molar extraction. It may be concluded that ibuprofen arginate could lead to a faster onset of analgesia compared to conventional ibuprofen, which makes it a valuable option for acute pain management after surgery. This rapid onset is attributed to the enhanced bioavailability of ibuprofen in its arginate salt form, which allows for quicker absorption and higher peak plasma concentrations over a shorter time frame. As a matter of fact, the results of [PERSON] et al. (2002), [PERSON] et al. (2002), and [PERSON] et al. (2002) show that ibuprofen arginate gave significantly better pain relief than conventional ibuprofen, respectively, within the first 15 to 60 min, 15 to 120 min, and 10 min up to 120 min. These results suggest that ibuprofen arginate has a faster onset of action and provides more pain relief during this initial period, without leading to a shorter overall duration of pain relief compared to conventional ibuprofen. Moreover, it must be pointed out that, after 6 h, ibuprofen arginate does not significantly differ in terms of pain reduction compared to ibuprofen at equivalent doses. [PERSON] et coll. (2002) observed that the time of re-medication was the same (4 h) for both ibuprofen arginate 400 mg and ibuprofen 400 mg, and both were significantly longer than the time recorded for ibuprofen 200 mg (2.6 h). Additionally, the re-medication time for ibuprofen arginate (3 h) was longer compared to ibuprofen 200 mg [31]. In the study of [PERSON] et al. (2002), the median times to re-medication were 4.0 h for ibuprofen arginate 200 mg and 4.5 h for 400 mg, while, for ibuprofen 200 mg and 400 mg, the times were 4.2 h and 5.2 h, respectively [28]. According to [PERSON] et al. (2002), the re-medication time was significantly longer for both ibuprofen arginate groups compared to patients treated with conventional ibuprofen 200 mg (4.5 h for ibuprofen arginate 200 mg and 4.4 h for ibuprofen arginate 400 mg vs. 3.8 h for conventional ibuprofen 200 mg and 4.2 h for conventional ibuprofen 400 mg [31]. All three studies evaluated the effect of ibuprofen arginate and conventional ibuprofen when local anesthesia dissipated, and the patients' pain was of moderate or severe intensity. Meanwhile, [PERSON] et al. (2009) assessed the effectiveness of 400 mg ibuprofen arginate when used as a preemptive or postoperative analgesic. Their study found no differences between preemptive and postoperative administration in terms of time to first rescue medication, total amount of rescue medication consumed, number of pain-free patients, pain scores, and global assessment scores [33]. The most recent randomized controlled trial by [PERSON] et al. (2022) further supports the benefits of ibuprofen arginine. The authors evaluated the pain intensity using the visual analog scale (VAS), and the ibuprofen arginine group showed pain level significantly lower (2.6 \(\pm\) 1) compared to the conventional ibuprofen group (5.0 \(\pm\) 1). In comparison to the ones mentioned above, this study went beyond pain management, also exploring the drug's effects on controlling postoperative edema and trismus following third molar extractions. The trial demonstrated that ibuprofen arginine was superior to conventional ibuprofen in reducing edema, though its effect on trismus was less pronounced [30]. Salification with arginine may enhance the anti-inflammatory effect of ibuprofen because L-arginine serves as a substrate for nitric oxide (NO)-synthesizing enzymes (NOGs). Nitric oxide regulates the activity of immune-competent cells and may help reduce inflammation [34; 35].