Baldawa Harsh, Tirupathi Sunnypriyatham, Ramakrishnan Mahesh, Gurunathan Deepa, Jeevanandan Ganesh, Ravindran Vignesh, Govindaraju Lavanya
Department of Pedodontics and Preventive Dentistry, Saveetha Dental College and Hospitals SIMATS, Chennai, India.
J Dent Anesth Pain Med. 2025 Aug;25(4):227-237. doi: 10.17245/jdapm.2025.25.4.227. Epub 2025 Jul 23.
The inferior alveolar nerve block (IANB) is one of the most painful procedures, especially in children. Effective pain management during IANB is a critical prerequisite for the successful treatment of pediatric patients. This systematic review aimed to evaluate the combined effectiveness of extraoral vibration and cooling (EVC) in reducing pain perception during IANB in children. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the compilation of this systematic review. PROSPERO registration was performed using registration number CRD42024558538. PubMed, ScienceDirect, Cochrane, Google Scholar, and LILACS were searched for relevant studies published from the inception of the databases until January 1, 2025. Studies that compared the use of EVC with conventional methods for IANB in children were selected. The primary and secondary outcomes were subjective and objective measures of pain, respectively. The initial search of the five electronic databases yielded 483 records. After excluding 113 duplicates and screening 309 irrelevant titles and abstracts, 61 studies were included. Of these, six were selected for full-text analysis, and three studies met the inclusion criteria for the final systematic review. Meta-analysis was feasible for two of these studies because of their comparable methodologies and outcome measures. All included studies involved pediatric patients aged 5-12 years undergoing IANB. The intervention group underwent IANB using a combination of EVC, whereas the control group underwent conventional IANB without adjuncts. Pain and anxiety were assessed using both subjective (Wong-Baker Faces Pain Scale) and objective (Face, Legs, Activity, Cry, Consolability) scoring systems. The results indicated a statistically significant reduction in pain scores in the EVC group than in the control group, suggesting that EVC may be an effective adjunct for improving pain perception during IANB in children. Pain perception during IANB was significantly lower in the combined EVC group than in the control group. However, meta-analysis reports indicated that there was no significant difference in pain perception between the intervention and control groups.
下牙槽神经阻滞（IANB）是最疼痛的操作之一，尤其是在儿童中。IANB期间有效的疼痛管理是成功治疗儿科患者的关键前提。本系统评价旨在评估口外振动与冷却（EVC）联合使用在降低儿童IANB期间疼痛感知方面的综合效果。本系统评价的编制遵循系统评价和Meta分析的首选报告项目指南。使用注册号CRD42024558538进行了PROSPERO注册。在PubMed、ScienceDirect、Cochrane、谷歌学术和LILACS中检索了从数据库建立到2025年1月1日发表的相关研究。选择了比较EVC与儿童IANB传统方法使用情况的研究。主要和次要结局分别是疼痛的主观和客观测量指标。对五个电子数据库的初步检索产生了483条记录。排除113条重复记录并筛选309条无关标题和摘要后，纳入了61项研究。其中，六项被选进行全文分析，三项研究符合最终系统评价的纳入标准。由于其中两项研究的方法和结局测量具有可比性，因此可以进行Meta分析。所有纳入研究均涉及5至12岁接受IANB的儿科患者。干预组使用EVC联合进行IANB，而对照组进行无辅助的传统IANB。使用主观（面部表情疼痛量表）和客观（面部、腿部、活动、哭闹、安抚）评分系统评估疼痛和焦虑。结果表明，EVC组的疼痛评分在统计学上显著低于对照组，这表明EVC可能是改善儿童IANB期间疼痛感知的有效辅助手段。联合EVC组IANB期间的疼痛感知显著低于对照组。然而，Meta分析报告表明，干预组和对照组之间的疼痛感知没有显著差异。
