术前口服类固醇与抗炎药相比对有症状的不可逆性牙髓炎下颌磨牙下牙槽神经阻滞麻醉成功率的影响——一项双盲随机临床试验
Effect of Preoperative Oral Steroids in Comparison to Anti-inflammatory on Anesthetic Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis-A Double-blinded Randomized Clinical Trial.
作者信息
Hegde Vivek, Shanmugasundaram Srilatha, Shaikh Samia, Kulkarni Vaidehi, Suresh Nandini, Setzer Frank C, Nagendrababu Venkateshbabu
机构信息
Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India.
Faculty of dentistry, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER), Tamilnadu, India.
出版信息
J Endod. 2023 Apr;49(4):354-361. doi: 10.1016/j.joen.2023.01.007. Epub 2023 Feb 2.
INTRODUCTION
This randomized double-blinded trial aimed to compare the anesthetic success of inferior alveolar nerve blocks (IANBs) with 2% lidocaine in mandibular molars with symptomatic irreversible pulpitis (SIP) after oral premedication of prednisolone, dexamethasone, and ketorolac with placebo.
METHODS
One hundred eighty-four patients diagnosed with SIP in mandibular molars randomly received prednisolone, dexamethasone, ketorolac, or placebo (n = 46 each) 60 minutes before the administration of an IANB. The access cavity preparation was initiated after successfully confirming lip numbness and two consecutive negative responses to electric pulp testing. The success of the anesthesia was clinically confirmed when pain was absent during the endodontic access or instrumentation. A one-way analysis of variance test was used to compare quantitative variables among the groups, and chi-square tests were used for comparing categorical variables. Binary logistic regression was performed to analyze the relationship of age, preoperative pain, and preoperative medications.
RESULTS
When premedicated with oral dexamethasone, ketorolac, prednisolone, and placebo, the success rate of IANB was determined to be 60.86 %, 65.21 %, 56.52 %, and 21.73 %, respectively. Compared to the placebo, the success rate of IANB was significantly increased when patients were premedicated with prednisolone, dexamethasone, or ketorolac. However, there were no statistically significant differences among prednisolone, dexamethasone, and ketorolac. One individual in the ketorolac group reported gastritis, whereas no adverse effects were reported in the dexamethasone or prednisolone groups.
CONCLUSIONS
Preoperative use of oral ketorolac, dexamethasone, or prednisolone may increase the anesthetic efficacy of IANB in mandibular molars with SIP.
引言
本随机双盲试验旨在比较在口服泼尼松龙、地塞米松和酮咯酸并给予安慰剂进行术前用药后，2%利多卡因在下颌磨牙有症状不可逆性牙髓炎（SIP）患者中进行下牙槽神经阻滞（IANB）的麻醉成功率。
方法
184例被诊断为下颌磨牙SIP的患者在进行IANB前60分钟随机接受泼尼松龙、地塞米松、酮咯酸或安慰剂（每组n = 46）。在成功确认唇部麻木且对牙髓电测试连续两次阴性反应后开始制备开髓洞形。当牙髓治疗开髓或器械操作过程中无疼痛时，临床确认麻醉成功。采用单因素方差分析比较各组间的定量变量，采用卡方检验比较分类变量。进行二元逻辑回归分析年龄、术前疼痛和术前用药之间的关系。
结果
口服地塞米松、酮咯酸、泼尼松龙和安慰剂进行术前用药时，IANB的成功率分别为60.86%、65.21%、56.52%和21.73%。与安慰剂相比，患者口服泼尼松龙、地塞米松或酮咯酸进行术前用药时，IANB的成功率显著提高。然而，泼尼松龙、地塞米松和酮咯酸之间无统计学显著差异。酮咯酸组有1例患者报告患胃炎，而地塞米松或泼尼松龙组未报告不良反应。
结论
术前口服酮咯酸、地塞米松或泼尼松龙可能会提高IANB在下颌磨牙SIP患者中的麻醉效果。
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