Faculty of Dentistry, Oral and Maxillofacial Surgery, Karamanoglu Mehmetbey University, Karaman, 70200, Turkey.
Faculty of Dentistry, Oral and Maxillofacial Surgery, Selçuk University University, Konya, 42130, Turkey.
BMC Oral Health. 2024 Jun 18;24(1):706. doi: 10.1186/s12903-024-04483-4.
Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited.
This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant.
The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups.
PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries.
This study was conducted at Ahmet Keleşoğlu Faculty of Dentistry with the permission of Karamanoğlu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024).
外科拔除阻生第三磨牙（ITM）常导致术后不适，包括疼痛、肿胀和功能受限。地塞米松（DXN）等类固醇类药物常用于口腔外科以缓解疼痛和炎症。DXN 有多种给药途径，包括静脉内（IV）、神经周围（PN）和口服应用，每种途径都有其优点。先前的研究表明，将 DXN 加入局部麻醉剂中可以延长麻醉持续时间并减少术后后遗症。然而，关于 ITM 手术中 IV 和 PN 应用与下牙槽神经阻滞（IANB）联合应用 DXN 的比较研究有限。
本研究为对照、随机、观察性研究，纳入行 II 类 B 位 ITM 拔除术的患者。患者分为三组。IANB（1.8ml 盐酸阿替卡因+1ml 生理盐水）在 IV 组给予 IV-DXN（4mg/ml DXN）后 1 小时进行。PN 组中，DXN 与 IANB（1.8ml 盐酸阿替卡因+1ml 4mg/ml DXN）一起应用。对照组仅给予 IANB（1.8ml 盐酸阿替卡因+1ml 生理盐水）。麻醉持续时间为主要观察指标。使用生命计从磨牙评估麻醉持续时间。次要观察指标包括术后第 1、3 和 7 天的疼痛和肿胀。术后疼痛采用视觉模拟评分进行评估。p 值<0.05 被认为具有统计学意义。
本研究共纳入了 45 名具有相似人口统计学特征的患者，各组之间无显著差异。与对照组相比，IV 应用显著延长了麻醉持续时间（p=0.049）。IV 和 PN 应用 DXN 均减少了术后第 3 天（p=0.048）和第 7 天（p=0.01）的肿胀。IV 组术后疼痛缓解显著（p=0.011）。然而，PN 组在第 3 天和第 7 天的疼痛并未像 IV 组和对照组那样减轻。
PN 和 IV DXN 给药可延长 ITM 手术中的麻醉持续时间并减轻术后肿胀。然而，PN DXN 给药与 IV DXN 和对照组相比，术后疼痛增加。需要进一步比较 DXN 的不同剂量和给药途径的研究，以确定在 ITM 手术中管理术后不适的最佳策略。
本研究在卡拉曼梅赫梅特贝大学医学院 Ahmet Keleşoğlu 牙科学院获得许可（#04-2022/101）。试验注册也可在 clinicaltrail.gov 上获得（NCT06318013，2024 年 5 月 26 日）。
