Shirvani A, Shamszadeh S, Eghbal M J, Asgary S
Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
J Oral Rehabil. 2017 Sep;44(9):709-721. doi: 10.1111/joor.12519. Epub 2017 May 23.
The objective of this review was to evaluate the efficacy of non-narcotic analgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post-operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta-regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta-analysis was performed using a random-effect inverse variance method. Meta-regression analysis was conducted to examine the associations between effect sizes and study-level covariates (P < 0·05). The results showed that administration of non-narcotic analgesic was more effective than placebo in the management of post-operative pain, resulting in a lower pain scores with a standardised mean difference of -0·50 (95% CI= -0·70, -0·30), -0·76 (95%CI= -0·95, -0·56), -1·15 (95% CI= -1·52, -0·78), -0·65 (95% CI= -1·05, -0·26) for immediately after the procedure, 6-, 12- and 24 h post-operative follow-ups (test for statistical heterogeneity: P = 0·000, P = 0·000, P = 0·000 and P = 0·001), respectively. Our meta-regression analysis provided the evidence for association between some study covariates with treatment effect, each at different follow-ups. We concluded that the clinicians can manage post-operative endodontic pain by administration of NSAIDs and/or paracetamol. However, analgesic regimens should be considered as important determinants when prescribing a pharmacological adjuvant.
本综述的目的是评估非麻醉性镇痛药（包括非甾体抗炎药（NSAIDs）和/或对乙酰氨基酚）治疗术后牙髓疼痛的疗效。此外，我们旨在通过Meta回归分析研究研究协变量与疼痛评分之间可能存在的关联。2016年进行了电子检索。在对纳入研究（n = 27，代表2188例患者）进行数据提取和质量评估后，采用随机效应逆方差法进行Meta分析。进行Meta回归分析以检验效应量与研究水平协变量之间的关联（P < 0.05）。结果显示，在术后疼痛管理中，给予非麻醉性镇痛药比给予安慰剂更有效，在术后即刻、术后6小时、12小时和24小时随访时疼痛评分更低，标准化均差分别为-0.50（95%CI = -0.70，-0.30）、-0.76（95%CI = -0.95，-0.56）、-1.15（95%CI = -1.52，-0.78）、-0.65（95%CI = -1.05，-0.26）（统计异质性检验：P = 0.000，P = 0.000，P = 0.000，P = 0.001）。我们的Meta回归分析为一些研究协变量与不同随访时间的治疗效果之间的关联提供了证据。我们得出结论，临床医生可以通过给予NSAIDs和/或对乙酰氨基酚来管理术后牙髓疼痛。然而，在开具药物辅助剂时，镇痛方案应被视为重要的决定因素。
