Costa Fábio Wildson Gurgel, Esses Diego Felipe Silveira, de Barros Silva Paulo Goberlânio, Carvalho Francisco Samuel Rodrigues, Sá Carlos Diego Lopes, Albuquerque Assis Filipe Medeiros, Bezerra Tácio Pinheiro, Ribeiro Thyciana Rodrigues, Sá Roriz Fonteles Cristiane, Soares Eduardo Costa Studart
Adjunct Professor, Division of Oral Radiology, School of Dentistry, Federal University of Ceará, Brazil.
Postgraduate Student, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil.
Anesth Prog. 2015 Summer;62(2):57-63. doi: 10.2344/0003-3006-62.2.57.
The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.
本研究旨在探讨非甾体抗炎药（NSAIDs）超前镇痛在第三磨牙手术中的有效性。使用以下术语（医学主题词表/医学主题词）或组合词，在PubMed数据库中检索仅限英文的文章：镇痛、第三磨牙和超前镇痛。在总共704篇文章中，选取了6篇（n = 420名受试者）。所有研究的偏倚风险均较低（根据Cochrane标准），但方法存在高度异质性。两项研究被排除在荟萃分析之外，因为它们没有用于计算的足够数值（二分数据）。超前镇痛在降低下颌阻生第三磨牙拔除术后疼痛方面未显示出显著益处（n = 298，P = 0.2227，比值比：2.30，0.60 - 8.73）。然而，NSAIDs在第三磨牙拔除超前镇痛中的有效性与其对环氧化酶-2（COX-2）的选择性之间可能存在直接关系。超前镇痛在降低下颌阻生第三磨牙拔除术后疼痛方面没有显著效果。需要更具同质性且界限清晰的临床研究来确定NSAIDs对COX-2的选择性与治疗效果之间可能存在的关联。
