Falci Saulo Gabriel Moreira, Lima Thiago César, Martins Carolina Castro, Santos Cássio Roberto Rocha Dos, Pinheiro Marcos Luciano Pimenta
Oral and Maxillofacial Surgery Professor, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
Master Student, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
Anesth Prog. 2017 Fall;64(3):136-143. doi: 10.2344/anpr-64-05-08.
The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti-inflammatories. An electronic search was conducted for preemptive effects related to lower third-molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta-analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split-mouth clinical trials were selected. Two studies were included in the meta-analysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti-inflammatories for preemptive effectiveness. Meta-analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = -1.28 to -0.38), 4 days (95% CI = -1.65 to -0.71), 7 days (95% CI = -1.42 to -0.71), and overall (95% CI = -1.25 to -0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI = 0.18 to 1.07). There is insufficient evidence through meta-analysis to conclude that dexamethasone is better than other nonsteroidal anti-inflammatories or methylprednisolone as a preemptive analgesic. The results of this meta-analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.
本研究的目的是评估预防性使用地塞米松在拔除下颌第三磨牙手术中的有效性，并将其与其他口服抗炎药进行比较。在3个独立数据库中进行了关于下颌第三磨牙手术预防性效果的电子检索。评估了疼痛、肿胀和张口受限等变量。采用荟萃分析计算均值和标准差的合并效应量（95%置信区间[CI]）。选择了7项双侧对照临床试验。两项研究纳入了荟萃分析。三项研究显示偏倚风险较低；两项研究显示中度风险，两项研究显示高风险。在地塞米松预防性效果方面，地塞米松优于非甾体抗炎药。荟萃分析显示，地塞米松在术后2天（95%CI = -1.28至-0.38）、4天（95%CI = -1.65至-0.71）、7天（95%CI = -1.42至-0.71）及总体（95%CI = -1.25至-0.72）的肿胀情况方面优于甲泼尼龙。地塞米松在术后4天的张口情况方面优于甲泼尼龙（95%CI = 0.18至1.07）。通过荟萃分析没有足够证据得出地塞米松作为预防性镇痛药比其他非甾体抗炎药或甲泼尼龙更好的结论。该荟萃分析结果表明，地塞米松在肿胀和张口受限方面比甲泼尼龙更有效。
