Department of Endodontics, Franciscan University, Santa Maria, RS, Brazil.
Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Eur Endod J. 2021 Apr;6(1):15-24. doi: 10.14744/eej.2020.85856. Epub 2021 Feb 2.
Prevention and management of postoperative endodontic pain is a common challenge for the endodontists. This systematic review was conducted to evaluate the efficacy and safety of medicament therapeutic protocols in the prevention and management of endodontic pain.
A literature search was undertaken in MEDLINE, Cochrane Library, LILACs, and SciELO, for articles published until December 2017, without year restriction and written only in English. An additional search was performed in the references of the retrieved studies. Study eligibility criteria, participants, and interventions: The inclusion criteria were randomised clinical trials that evaluated the use of medications to prevent or control moderate to severe pain in adult patients, using a visual analog scale as a tool for pain measurement. The primary outcome evaluated was the reduction of pain scores. The second outcome evaluated was the need for additional analgesia and the occurrence of adverse events.
The quality assessment of the included studies was performed following the Jadad scale to measure the likelihood of bias in pain research reports.
After removing duplicates and excluding the studies that did not meet the selection criteria, ten studies were included tin the systematic review. Among these studies, five studies administered the medications before the endodontic procedures and five studies after. These studies evaluated non-opioid analgesics (acetaminophen), opioid analgesics (tramadol and codeine), nonsteroidal anti-inflammatories (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen), steroidal anti-inflammatory (prednisolone) or the association of medications to prevent or control postoperative pain. It was possible to establish a significant relationship between the use of additional analgesics and periapical diagnosis. Adverse events were not observed when the administration occurred before the endodontic procedure. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis.
A restricted number of randomised clinical trials were found, and the difference in the methodology of the studies did not meet the definition of a systemic treatment protocol for prevention or control of postoperative pain.
Nonsteroidal anti-inflammatory drugs are the most common medicament to prevent and control postoperative pain, with ibuprofen being the most investigated. There is a significant association between the use of additional analgesics and periapical diagnoses.
预防和处理根管治疗术后疼痛是牙髓病医生面临的共同挑战。本系统评价旨在评估药物治疗方案在预防和处理根管治疗术后疼痛方面的疗效和安全性。
对 MEDLINE、Cochrane 图书馆、LILACS 和 SciELO 进行文献检索，检索截至 2017 年 12 月的文献，无年限限制，且仅以英文发表。对检索到的研究参考文献进行了额外检索。研究纳入标准、参与者和干预措施：纳入标准为随机临床试验，评估药物用于预防或控制成年患者中度至重度疼痛的效果，使用视觉模拟评分法作为疼痛测量工具。评估的主要结果是疼痛评分的降低。评估的次要结果是需要额外镇痛和不良事件的发生。
采用 Jadad 量表评估纳入研究的质量，以评估疼痛研究报告中偏倚的可能性。
在去除重复项并排除不符合选择标准的研究后，10 项研究被纳入系统评价。在这些研究中，5 项研究在根管治疗前给予药物，5 项研究在根管治疗后给予药物。这些研究评估了非阿片类镇痛药（对乙酰氨基酚）、阿片类镇痛药（曲马多和可待因）、非甾体抗炎药（布洛芬、氟比洛芬、酮咯酸氨丁三醇、依托度酸、替诺昔康和萘普生）、甾体抗炎药（泼尼松龙）或联合用药预防或控制术后疼痛。在使用额外镇痛剂与根尖周诊断之间可以建立显著的关系。当给药发生在根管治疗前时，未观察到不良事件。当治疗发生在根管治疗后时，分析中纳入的 3 项试验中有 2 项报告了不良反应。
发现的随机临床试验数量有限，且研究方法的差异不符合预防或控制术后疼痛的系统治疗方案的定义。
非甾体抗炎药是最常用于预防和控制术后疼痛的药物，其中布洛芬的研究最多。在使用额外镇痛剂和根尖周诊断之间存在显著的关联。
