Jose Jerry, Teja Kavalipurapu Venkata, Palanivelu Ajitha, Khandelwal Akshay, Siddique Riluwan
Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
Department of Conservative Dentistry and Endodontics, Mamata Institute of Dental Sciences, Bachupally, Hyderabad, Telangana State, India.
J Conserv Dent. 2022 Jan-Feb;25(1):9-19. doi: 10.4103/jcd.jcd_30_21. Epub 2022 May 2.
Analgesic medications in dentistry are indicated for the relief of acute pain, postoperative pain, chronic pain as well as controlling adjunctive intraoperative pain. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has shown an effective reduction of postendodontic pain by action on the cyclooxygenase pathway. Another medication which is used recently is corticosteroid which enables the reduction of pain. They are hormones secreted from the adrenal gland and have strong anti-inflammatory actions. This review aims to compare the analgesic efficacy of NSAIDs and corticosteroids when administered through oral route for reducing postendodontic pain. The secondary objective was to assess the anesthetic effect of the nerve block when an oral premedication of NSAIDs or corticosteroids was administered. The databases of PubMed, ScienceDirect, LILACS, and Cochrane were searched for related topics from 1983 to April 2020. Bibliographies of clinical studies were identified in the electronic search. Clinical studies with postendodontic pain reduction using NSAIDs and corticosteroids were selected. Clinical studies that met all inclusion criteria were reviewed. Data extraction was performed independently by two reviewers. All individuals who administered single dose analgesic (NSAID or corticosteroid) before initiating root canal treatment were taken into inclusion criteria. All the relevant data were extracted from the selected studies were reviewed by two independent reviewers using a standardized data collection form, and in case of disagreement, a third reviewer was enquired to achieve a consensus. Risk of bias of the selected studies was done using Cochrane Risk of Bias Tool (version 1). Mean pain score levels at various time intervals showed an increased analgesic success rate for corticosteroids ( 32-1) in comparison to NSAIDs ( 32-21.4). Anesthetic effect of the nerve block administered was seen to be better when an oral premedication of corticosteroids (38.2%-80.8%) was given in comparison to NSAID (25.5%-73.1%). From the present study, it can be concluded that oral administration of corticosteroids provides a better analgesic efficacy when compared to NSAIDs as an oral premedication for postoperative pain reduction. It can also be concluded that corticosteroids when used as an oral premedication provide a better anesthetic effect of the nerve block administered when compared to NSAIDs given as an oral premedication. These findings could help the clinician determine which pretreatment analgesic would have a better effect in reduction of pain posttreatment as well as increasing the anesthetic efficacy of administered block. Systematic Review Registration Number: CRD42021235394.
牙科用镇痛药适用于缓解急性疼痛、术后疼痛、慢性疼痛以及控制术中辅助性疼痛。使用非甾体抗炎药（NSAIDs）已显示出通过作用于环氧化酶途径有效减轻根管治疗后疼痛。最近使用的另一种药物是皮质类固醇，它能够减轻疼痛。它们是肾上腺分泌的激素，具有强大的抗炎作用。本综述旨在比较NSAIDs和皮质类固醇经口服途径给药以减轻根管治疗后疼痛时的镇痛效果。次要目的是评估在给予NSAIDs或皮质类固醇口服预处理后神经阻滞的麻醉效果。检索了PubMed、ScienceDirect、LILACS和Cochrane数据库中1983年至2020年4月的相关主题。在电子检索中识别临床研究的参考文献。选择使用NSAIDs和皮质类固醇减轻根管治疗后疼痛的临床研究。对符合所有纳入标准的临床研究进行综述。由两名 reviewers 独立进行数据提取。所有在开始根管治疗前给予单剂量镇痛药（NSAID或皮质类固醇）的个体均纳入纳入标准。从选定研究中提取的所有相关数据由两名独立 reviewers 使用标准化数据收集表进行审查，如有分歧，则询问第三名reviewer以达成共识。使用Cochrane偏倚风险工具（第1版）对选定研究的偏倚风险进行评估。与NSAIDs（32 - 21.4）相比，皮质类固醇（32 - 1）在不同时间间隔的平均疼痛评分水平显示出更高的镇痛成功率。与NSAID（25.5% - 73.1%）相比，给予皮质类固醇口服预处理（38.2% - 80.8%）时，所给予的神经阻滞麻醉效果更好。从本研究可以得出结论，与NSAIDs作为口服预处理用于减轻术后疼痛相比，口服皮质类固醇具有更好的镇痛效果。还可以得出结论，与作为口服预处理给予的NSAIDs相比，皮质类固醇作为口服预处理时，所给予的神经阻滞麻醉效果更好。这些发现可以帮助临床医生确定哪种预处理镇痛药在减轻治疗后疼痛以及提高所给予阻滞的麻醉效果方面具有更好的效果。系统评价注册号：CRD42021235394。
