Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
J Endod. 2019 Apr;45(4):364-371. doi: 10.1016/j.joen.2018.10.016. Epub 2019 Feb 6.
This review aimed to find the most effective oral premedication in reducing pain in adults after nonsurgical root canal therapy (NSRCT) using network meta-analysis.
The review protocol was registered in the PROSPERO database (CRD42017071899). A literature search was performed in the MEDLINE and EBSCOhost databases until June 2017 with no language restriction. Randomized controlled trials evaluating the efficacy of oral premedications, whether given alone or in combination, compared with other agents, placebo, or no treatment in adult patients before NSRCT for postoperative pain were included. Nonintervention studies, nonendodontic studies, animal studies, and reviews were excluded. The quality of the studies was assessed using the revised Cochrane risk of bias tool. Pair-wise meta-analysis, network meta-analysis, and quality of evidence assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria was performed.
Eleven studies comparing pharmacologic groups of medications were included in the primary analysis. Compared with placebo, corticosteroids (prednisolone 30-40 mg) was ranked best for reducing postoperative pain (median difference [MD] = -18.14 [95% confidence interval (CI), -32.90 to -3.37] for the pain score at 6 hours; MD = -22.17 [95% CI, -36.03 to -8.32] for the pain score at 12 hours; and MD = -21.50 [95% CI, -37.95 to -5.06] for the pain score at 24 hours). However, the evidence was very low (6 and 24 hours) to moderate quality (12 hours). Nonsteroidal anti-inflammatory drugs were ranked least among the medications, and the quality of this evidence was very low. Additional analysis based on the chemical name showed that sulindac, ketorolac, and ibuprofen significantly reduced pain at 6 hours, whereas piroxicam and prednisolone significantly reduced the pain at 12 and 24 hours. Etodolac was found to be least effective in reducing pain. Overall, the evidence was of moderate to very low quality.
Based on the limited and low-quality evidence, oral premedication with piroxicam or prednisolone could be recommended for controlling postoperative pain after NSRCT. However, more trials are warranted to confirm the results with a higher quality of evidence.
本综述旨在通过网络荟萃分析，找出非手术根管治疗（NSRCT）后减轻成人疼痛最有效的口服预用药。
本综述方案在 PROSPERO 数据库（CRD42017071899）中注册。检索 MEDLINE 和 EBSCOhost 数据库，检索截至 2017 年 6 月，不限制语言。纳入评估口服预用药（单独或联合使用）与其他药物、安慰剂或 NSRCT 前无治疗相比，在减轻成年患者术后疼痛方面疗效的随机对照试验。排除非干预性研究、非牙髓研究、动物研究和综述。使用修订后的 Cochrane 偏倚风险工具评估研究质量。进行两两荟萃分析、网络荟萃分析和使用 Grading of Recommendations Assessment, Development and Evaluation 标准评估证据质量。
纳入了 11 项比较药物类别的药理学研究。与安慰剂相比，皮质类固醇（泼尼松龙 30-40mg）在降低术后疼痛方面排名最佳（6 小时疼痛评分的中位数差值[MD]=-18.14[95%置信区间（CI），-32.90 至-3.37]；12 小时疼痛评分的 MD=-22.17[95%CI，-36.03 至-8.32]；24 小时疼痛评分的 MD=-21.50[95%CI，-37.95 至-5.06]）。然而，证据质量为极低（6 和 24 小时）至中等质量（12 小时）。非甾体抗炎药在药物中排名最低，证据质量也极低。基于化学名称的进一步分析表明，舒林酸、酮咯酸和布洛芬可显著降低 6 小时疼痛，而吡罗昔康和泼尼松龙可显著降低 12 和 24 小时疼痛。依托度酸在减轻疼痛方面效果最差。总的来说，证据质量为中等至极低。
基于有限的低质量证据，建议使用吡罗昔康或泼尼松龙进行口服预用药以控制 NSRCT 后的术后疼痛。然而，需要更多的试验来证实具有更高证据质量的结果。
