The Safety and Efficacy of Pre- and Post-Medication for Postoperative Endo- dontic Pain: A Systematic Review and Network Meta-analysis

Abstract

Background: Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain. Methods: A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI). Results: This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac. Conclusion: The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.

Effect of Preoperative Single Dose of Sodium Ibuprofen Versus Placebo on Postoperative Pain for Patient With Symptomatic Irreversible Pulpitis Related to Mandibular Molar Teeth: Double Blind Randomized Controlled Trial.

“…Several Systematic reviews reported that the preoperative use of a single dose of NSAIDs such as Ibuprofen, Tenoxicam, Rofecoxib, Etodolac, Piroxicam, Ketoprofen, Diflunisal, Fast acting ibuprofen, Flurbiprofen, Naproxen, Lornoxicam, Celecoxib, Ketorolac, Mefenamic acid, Endomethacin, Diclofenac, and Nemosulide are effective in reducing the post-operative pain ( 28,29,30,31,32,13) .…”

Methodological assessment and overall confidence in the results of systematic reviews with network meta‐analyses in Endodontics

“…Amongst the 12 reviews, ten included clinical trials, and two included laboratory-based studies. The software used to conduct the individual NMAs were WinBUGS (Lin et al, 2014), STATA (Nagendrababu et al, 2019a(Nagendrababu et al, , 2019b, program R (Zanjir et al, 2019(Zanjir et al, , 2020, MetaXL (Sivaramakrishnan et al, (2019) and R version (Almuthhin et al, 2020).…”

“…The overall confidence in the results of the reviews is described in Table 2. The overall confidence in the results of eight reviews were categorized as 'Critically low' (Almuthhin et al, 2020;Dioguardi et al, 2021;Lin et al, 2014;Sivaramakrishnan et al, 2019;de Souza Matos et al, 2021;Tedesco et al, 2020;Zanjir et al, 2019Zanjir et al, , 2020, one review was 'Low' (Nagendrababu et al, 2019b), two reviews were 'Moderate' (Nagendrababu et al, 2019a;Pulikkotil et al, 2018) and one review was 'High' (Khater et al, 2021).…”