Li Chunjie, Yang Xianrui, Ma Xiangyu, Li Longjiang, Shi Zongdao
State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China.
Quintessence Int. 2012 Mar;43(3):209-19.
To assess the effect and safety of pre-emptive oral nonsteroidal anti-inflammatory drugs (NSAIDs) for the success of inferior alveolar nerve block (IANB) in irreversible pulpitis treatment.
Medline (via OVID, 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2011), EMBASE (via OVID, 1984 to July 2011), Chinese BioMedical Literature Database (1978 to July 2011), China National Knowledge Infrastructure (1994 to July 2011), and WHO International Clinical Trials Registry Platform were searched electronically. In addition, relevant journals as well as reference lists of included studies were hand searched for randomized clinical trials comparing the effect or safety of NSAIDs in irreversible pulpitis treatment. Risk of bias assessment with the Cochrane collaboration tool and data extraction were independently performed by two reviewers. Meta-analysis was delivered with RevMan 5.1.
Seven studies were included. Six of them had low risk of bias, and one had an unclear risk of bias. A dosage of 600 to 800 mg of ibuprofen showed a significant effect in increasing the success rate of IANB (relative risk [RR], 1.52; 95% confidence interval [CI], 1.17 to 1.98; P = .002), and the results were moderately reliable. A dosage of 75 mg of indomethacin had a significant effect compared to a placebo (RR, 1.94; 95% CI, 1.22 to 3.06; P = .005), as did 8 mg of lornoxicam (RR, 2.80; 95% CI, 1.59 to 4.93; P = .0004) and 50 mg of diclofenac potassium (RR, 2.40; 95% CI, 1.34 to 4.31; P = .003). Other NSAIDs such as ketorolac, ibuprofen and acetaminophen together, and acetaminophen alone showed no statistical significance compared to the placebo. No serious adverse events were reported.
The clinical evidence suggests that pre-emptive oral NSAIDs might have a good effect and are safe in increasing the success rate of IANB, but more studies are necessary to confirm such outcomes.
评估在不可逆性牙髓炎治疗中，预先口服非甾体抗炎药（NSAIDs）对下牙槽神经阻滞（IANB）成功率的影响及安全性。
通过电子检索Medline（经OVID，1948年至2011年7月）、Cochrane对照试验中心注册库（CENTRAL，2011年第2期）、EMBASE（经OVID，1984年至2011年7月）、中国生物医学文献数据库（1978年至2011年7月）、中国知网（1994年至2011年7月）以及世界卫生组织国际临床试验注册平台。此外，还手动检索了相关期刊以及纳入研究的参考文献列表，以查找比较NSAIDs在不可逆性牙髓炎治疗中的效果或安全性的随机临床试验。两名评审员独立使用Cochrane协作工具进行偏倚风险评估并提取数据。使用RevMan 5.1进行荟萃分析。
纳入七项研究。其中六项偏倚风险较低，一项偏倚风险不明确。600至800毫克布洛芬的剂量在提高IANB成功率方面显示出显著效果（相对风险[RR]，1.52；95%置信区间[CI]，1.17至1.98；P = 0.002），结果具有中等可靠性。与安慰剂相比，75毫克吲哚美辛的剂量有显著效果（RR，1.94；95%CI，1.22至3.06；P = 0.005），8毫克氯诺昔康（RR，2.80；95%CI，1.59至4.93；P = 0.0004）和50毫克双氯芬酸钾（RR，2.40；95%CI，1.34至4.31；P = 0.003）也是如此。其他NSAIDs，如酮咯酸、布洛芬和对乙酰氨基酚联合使用，以及单独使用对乙酰氨基酚，与安慰剂相比无统计学意义。未报告严重不良事件。
临床证据表明，预先口服NSAIDs在提高IANB成功率方面可能具有良好效果且安全，但需要更多研究来证实这些结果。
