Pulikkotil S J, Nagendrababu V, Veettil S K, Jinatongthai P, Setzer F C
Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
Int Endod J. 2018 Sep;51(9):989-1004. doi: 10.1111/iej.12912. Epub 2018 Mar 24.
This systematic review (SR; PROSPERO database: CRD42017075160) and network meta-analysis (NMA) identified the most effective oral premedication for anaesthetic success of inferior alveolar nerve blocks (IANB) in cases of irreversible pulpitis. Medline and Ebscohost databases were searched up until 10/2017. Randomized controlled trials (RCT) studying the effect of oral premedication, alone or in combination, on the success of IANB for cases of irreversible pulpitis, compared to placebo or other oral premedications, were included. Quality of the included studies was appraised by the revised Cochrane risk of bias tool for randomized trials. Pairwise analysis, NMA and quality of evidence assessment using GRADE criteria were performed. Nineteen studies (n = 1654 participants) were included. NMA demonstrated that compared to placebo, dexamethasone was most effective in increasing anaesthetic success (RR, 2.92 [95% CI 1.74,4.91]; SUCRA = 0.96), followed by NSAIDs (RR, 1.92 [95% CI 1.63,2.27], SUCRA = 0.738) and Tramadol (RR, 2.03 [95% CI 1.18,3.49], SUCRA = 0.737). Premedication with acetaminophen added to NSAIDs demonstrated similar efficacy as NSAIDs alone (RR, 1.06 [95% CI 0.79,1.43]). Sensitivity analyses proved the superiority of dexamethasone or NSAIDs over any other premedications. Subgroup analyses of specific dosages in comparison with placebo demonstrated that dexamethasone 0.5 mg was most effective, followed by ketorolac 10 mg, piroxicam 20 mg, ibuprofen 400 mg + acetaminophen 500 mg and Tramadol 50 mg. Ibuprofen 400 mg, 600 mg and 800 mg had a significantly improved IANB success, while Ibuprofen 300 mg had no effect. Oral premedication with dexamethasone, NSAIDs or Tramadol significantly increased anaesthetic success. More trials are needed to evaluate the premedication effects of dexamethasone or Tramadol for improved anaesthetic success of IANB when treating irreversible pulpitis.
本系统评价（SR；PROSPERO数据库：CRD42017075160）和网状Meta分析（NMA）确定了在不可逆性牙髓炎病例中，用于下牙槽神经阻滞（IANB）麻醉成功的最有效口服术前用药。检索了Medline和Ebscohost数据库直至2017年10月。纳入了研究口服术前用药单独或联合使用对不可逆性牙髓炎病例中IANB成功效果的随机对照试验（RCT），并与安慰剂或其他口服术前用药进行比较。采用修订的Cochrane随机试验偏倚风险工具对纳入研究的质量进行评估。进行了成对分析、NMA以及使用GRADE标准的证据质量评估。纳入了19项研究（n = 1654名参与者）。NMA表明，与安慰剂相比，地塞米松在提高麻醉成功率方面最有效（RR，2.92 [95% CI 1.74,4.91]；累积排序曲线下面积（SUCRA）= 0.96），其次是非甾体抗炎药（NSAIDs）（RR，1.92 [95% CI 1.63,2.27]，SUCRA = 0.738）和曲马多（RR，2.03 [95% CI 1.18,3.49]，SUCRA = 0.737）。NSAIDs加用对乙酰氨基酚的术前用药显示出与单独使用NSAIDs相似的疗效（RR，1.06 [95% CI 0.79,1.43]）。敏感性分析证明地塞米松或NSAIDs优于任何其他术前用药。与安慰剂相比，特定剂量的亚组分析表明，0.5 mg地塞米松最有效，其次是10 mg酮咯酸、20 mg吡罗昔康、400 mg布洛芬 + 500 mg对乙酰氨基酚和50 mg曲马多。400 mg、600 mg和800 mg布洛芬显著提高了IANB成功率，而300 mg布洛芬无效。口服地塞米松、NSAIDs或曲马多进行术前用药显著提高了麻醉成功率。在治疗不可逆性牙髓炎时，需要更多试验来评估地塞米松或曲马多的术前用药效果，以提高IANB的麻醉成功率。
