Smith Elizabeth A, Marshall J Gordon, Selph Shelley S, Barker Dale R, Sedgley Christine M
Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon.
Pacific Northwest Evidence-based Practice Center, Oregon Health and Science University, Portland, Oregon.
J Endod. 2017 Jan;43(1):7-15. doi: 10.1016/j.joen.2016.09.010. Epub 2016 Dec 6.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperative pain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome, Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthograde endodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics or placebo in reducing postoperative pain and the incidence of adverse events.
Ovid MEDLINE (1946-December 15, 2015), the Cochrane Database of Systematic Reviews (2005-December 15, 2015), and the Cochrane Central Register of Controlled Trials (to December 15, 2015) were searched using included drugs, indications, and study designs as search terms. Hand searches in texts were also conducted. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. L'Abbe plots were used for qualitative review. Where applicable, meta-analysis was conducted on the pooled effect size (ES).
Two thousand two hundred eighty-four studies were identified through the database searches; 405 full-text articles were assessed. Fifteen articles met the inclusion criteria; qualitative analysis revealed all studies had a moderate to high risk of bias. Ibuprofen was the most studied NSAID. The L'Abbe plots showed that NSAIDS are effective at relieving postoperative endodontic pain overall. Meta-analysis showed that ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively (ES = 10.50, P = .037), and ibuprofen 600 mg + acetaminophen 1000 mg combination is more effective than placebo (ES = 34.89, P = .000) but not significantly different than ibuprofen (ES = 13.94, P = .317). Five studies reported patients experiencing adverse events such as drowsiness, dizziness, nausea, and emesis; 2 studies reported that patients experienced no adverse events.
A combination of ibuprofen 600 mg and acetaminophen 1000 mg is more effective than placebo but not significantly different than ibuprofen 600 mg at 6 hours postoperatively. Ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively; however, there are insufficient data to recommend the most effective NSAID, dose amount, or dose interval for the relief of postoperative endodontic pain of longer duration in patients with preoperative pain.
非甾体抗炎药（NSAIDs）一直被广泛用于治疗牙髓治疗术后疼痛。本研究的目的是解决以下人群、干预措施、对照、结局、时间、研究设计和研究背景问题：在接受初次常规牙髓治疗且术前有疼痛的患者中，与非麻醉性镇痛药或安慰剂相比，NSAIDs在减轻术后疼痛及不良事件发生率方面的比较疗效如何。
以纳入的药物、适应证和研究设计为检索词，检索了Ovid MEDLINE（1946年至2015年12月15日）、Cochrane系统评价数据库（2005年至2015年12月15日）和Cochrane对照试验中心注册库（截至2015年12月15日）。还对手稿进行了手工检索。两名独立的评审员评估纳入资格、提取数据并使用偏倚风险工具评估质量。采用L'Abbe图进行定性评价。在适用的情况下，对合并效应量（ES）进行荟萃分析。
通过数据库检索共识别出2284项研究；评估了405篇全文文章。15篇文章符合纳入标准；定性分析显示所有研究均存在中度至高偏倚风险。布洛芬是研究最多的NSAID。L'Abbe图显示，NSAIDs总体上对缓解牙髓治疗术后疼痛有效。荟萃分析表明，术后6小时，600 mg布洛芬比安慰剂更有效（ES = 10.50，P = 0.037），600 mg布洛芬 + 1000 mg对乙酰氨基酚组合比安慰剂更有效（ES = 34.89, P = 0.000），但与布洛芬相比无显著差异（ES = 13.94, P = 0.317）。5项研究报告患者出现嗜睡、头晕、恶心和呕吐等不良事件；2项研究报告患者未出现不良事件。
术后6小时，600 mg布洛芬与1000 mg对乙酰氨基酚联合使用比安慰剂更有效，但与600 mg布洛芬相比无显著差异。术后6小时，600 mg布洛芬比安慰剂更有效；然而，尚无足够数据推荐最有效的NSAID、剂量或给药间隔用于缓解术前有疼痛患者的较长时间牙髓治疗术后疼痛。
