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Background: Surgical removal of impacted mandibular third molars is a common procedure in oral and maxillofacial surgery, often associated with postoperative pain, facial swelling, and trismus. While standard analgesics provide relief, multimodal analgesia using pregabalin has shown promise in mitigating these complications.

Objective: The study was done to compare postoperative pain, facial swelling and interincisal distance following third molar extraction in patients with or without pregabalin.

Materials and Methods: A prospective, comparative study was conducted on 136 patients requiring bilateral mandibular third molar extractions. Each patient served as their own control, receiving pregabalin with standard analgesia for one extraction and only standard analgesia for the other. Pain was assessed using the Visual Analogue Scale (VAS) at various intervals, while facial swelling and interincisal distance were measured on postoperative days 1, 3, 7, and 14.

Results: Visual Analogue Scale (VAS) scores were consistently lower in the pregabalin group (p = 0.000), though differences were not statistically significant. Percentage facial swelling was significantly reduced in the pregabalin group on postoperative days 1 (p = 0.009) and 3 (p = 0.004). However, no significant differences were observed on days 7 and 14. Similarly, there was no statistically significant improvement in interincisal distance between groups.

Conclusion: Pregabalin demonstrates efficacy as an adjuvant therapy for reducing early postoperative pain and swelling following third molar extraction. Further multicenter, randomized, double-blinded trials are recommended to validate these findings and optimize pregabalin use in oral surgical care.

Pain; pregabalin; swelling; third molar surgery; trismus.