Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials

Author:

Costa Fábio Wildson Gurgel1,Esses Diego Felipe Silveira2,de Barros Silva Paulo Goberlânio3,Carvalho Francisco Samuel Rodrigues2,Sá Carlos Diego Lopes4,Albuquerque Assis Filipe Medeiros4,Bezerra Tácio Pinheiro5,Ribeiro Thyciana Rodrigues6,Fonteles Cristiane Sá Roriz7,Soares Eduardo Costa Studart8

Affiliation:

1. Adjunct Professor, Division of Oral Radiology, School of Dentistry, Federal University of Ceará, Brazil

2. Postgraduate Student, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil

3. Postgraduate Student, Division of Clinical Dentistry, UFC, Fortaleza-CE, Brazil

4. Postgraduate Student, Division of Oral Surgery, Post-program in Dentistry, Federal University of Ceará, Fortaleza-CE, Brazil

5. Professor, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil

6. Adjunct Professor, Division of Special Needs Dental Patients, UFC, Fortaleza-CE, Brazil

7. Associate Professor, Division of Pediatric Dentistry, UFC, Fortaleza-CE, Brazil

8. Full Professor, Division of Oral Surgery, UFC, Fortaleza-CE, Brazil

Abstract

Abstract The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n = 420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n = 298, P = .2227, odds ratio: 2.30, 0.60–8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.

Publisher

American Dental Society of Anesthesiology (ADSA)

Subject

Anesthesiology and Pain Medicine

Reference19 articles.

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