University of Pernambuco, School of Dentistry Oswaldo Cruz University Hospital Department of Oral and Maxillofacial Surgery Rua Arnóbio Marquês, 310, Santo Amaro 50100-130, Recife, Pernambuco, Brazil
Med Oral Patol Oral Cir Bucal. 2022 Nov 1;27(6):e560-e568. doi: 10.4317/medoral.25498.
Third molar extraction is among the most common surgical procedures performed by oral-maxillofacial surgeons. Postoperative pain, swelling and trismus are common, especially in wisdom teeth, due to trauma to local tissues and the duration of the surgical procedure, among other factors.
This systematic review was conducted in accordance with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' in order to answer the focused question: 'Is the local submucosal injection of tramadol effective at the control of postoperative pain in patients submitted to impacted mandibular third molar extractions?'. We analyzed papers published until March 30, 2021 in the MEDLINE|PubMed, Web of Science and Cochrane Library databases. Gray literature was also consulted. Standard pairwise meta-analyses of direct comparisons were performed using a fixed-effect model; I2 ≥ 50 % or ≥ 75 % indicated moderate or high heterogeneity, respectively. Risk of bias was assessed by Cochrane Collaboration's tool.
In total, 172 participants (98 males and 74 females, aged 18 or over) from three randomized placebo-controlled trials were considered for analysis. The submucosal injection of 2 ml of tramadol adjacent to the impacted mandibular third molar was effective in controlling pain up to 6-hours after surgery, in increasing the onset of consumption of rescue analgesic and in reducing the total number of rescue analgesics used.
The submucosal injection of tramadol can be considered a safe and effective procedure for pain control after impacted mandibular third molar extractions.
第三磨牙拔除术是口腔颌面外科最常见的手术之一。术后疼痛、肿胀和牙关紧闭是常见的，尤其是在智齿，由于局部组织损伤和手术持续时间等因素。
本系统评价按照“系统评价和荟萃分析的首选报告项目”进行，以回答重点问题：“在接受下颌阻生第三磨牙拔除术的患者中，局部黏膜下注射曲马多是否能有效控制术后疼痛？”。我们分析了截至 2021 年 3 月 30 日在 MEDLINE|PubMed、Web of Science 和 Cochrane Library 数据库中发表的论文。还查阅了灰色文献。使用固定效应模型对直接比较进行标准成对荟萃分析；I2≥50%或≥75%分别表示中度或高度异质性。使用 Cochrane 协作工具评估偏倚风险。
共有 172 名参与者（98 名男性和 74 名女性，年龄在 18 岁或以上）来自三项随机安慰剂对照试验被纳入分析。在受影响的下颌第三磨牙附近黏膜下注射 2 毫升曲马多，在术后 6 小时内有效控制疼痛，增加了使用救援性镇痛药的开始时间，并减少了使用的救援性镇痛药的总数。
黏膜下注射曲马多可被认为是一种安全有效的下颌阻生第三磨牙拔除术后控制疼痛的方法。
