Is the combination of corticosteroids plus NSAIDs improve the preemptive analgesia after third molars surgery? A systematic review and meta-analysis

Authors

DOI:

https://doi.org/10.33448/rsd-v9i9.7979

Keywords:

Molar, Third; Pain; Adrenal cortex hormones; Inflammation; Inflammation mediators; Anti-inflammatory agents; Anti-inflammatory non-steroidal; inflammation

Abstract

This study aimed to perform a systematic review and meta-analysis to evaluate the preemptive action of the combination of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) or both drugs singly after third molars surgery. It was performed a search on the PubMed/MEDLINE, Scopus, and Cochrane databases, according to the PRISMA criteria, with no time restrictions up to March 2020. The postoperative pain was evaluated, qualitatively, through the visual analogue scale (VAS) and the number of rescue analgesics (NRA). The edema and trismus were evaluated in a qualitative way through linear measures. Besides that, a meta-analysis of the post-operative pain (VAS) was performed. It was found 103 articles, which four articles were selected according to the inclusion and exclusion criteria. A total of 208 patients was evaluated and the combination of corticosteroids and NSAIDs showed great behavior in the preemptive action after third molars surgery for all the parameters evaluated when compared to both drugs singly. Meta-analysis about the VAS showed that the combination of drugs reduced significantly the postoperative pain when compared to the NSAIDs singly (P<0.05). It was concluded that the combination of NSAIDs and corticosteroids improved postoperative pain, edema, and trismus after third molars surgery.

References

Alcântara, C. E., Falci, S. G., Oliveira-Ferreira, F., Santos, C. R., & Pinheiro, M. L. (2014). Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind clinical trial. International journal of oral and maxillofacial surgery, 43(1), 93–98.

Annibali, S., Bignozzi, I., Cristalli, M. P., Graziani, F., La Monaca, G., & Polimeni, A. (2012). Peri-implant marginal bone level: a systematic review and meta-analysis of studies comparing platform switching versus conventionally restored implants. Journal of clinical periodontology, 39(11), 1097–1113.

Antunes, A. A., Avelar, R. L., Martins Neto, E. C., Frota, R., & Dias, E. (2011). Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery. Oral and maxillofacial surgery, 15(4), 217–223.

Atieh, M. A., Ibrahim, H. M., & Atieh, A. H. (2010). Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis. Journal of periodontology, 81(10), 1350–1366.

Aznar-Arasa, L., Harutunian, K., Figueiredo, R., Valmaseda-Castellón, E., & Gay-Escoda, C. (2012). Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial. International Journal Of Oral And Maxillofacial Surgery, 41(8), 1005-1009.

Bamgbose, B., Akinwande, J., Adeyemo, W., Ladeinde, A., Arotiba, G., & Ogunlewe, M. (2005). Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head & Face Medicine, 1(1).

Barbalho, J. C., Vasconcellos, R. J., de Morais, H. H., Santos, L. A., Almeida, R. A., Rêbelo, H. L., Lucena, E. E., & de Araújo, S. Q. (2017). Effects of co-administered dexamethasone and nimesulide on pain, swelling, and trismus following third molar surgery: a randomized, triple-blind, controlled clinical trial. International journal of oral and maxillofacial surgery, 46(2), 236–242.

Barden, J., Edwards, J. E., McQuay, H. J., & Andrew Moore, R. (2004). Pain and analgesic response after third molar extraction and other postsurgical pain. Pain, 107(1-2), 86–90.

Bauer, H. C., Duarte, F. L., Horliana, A. C., Tortamano, I. P., Perez, F. E., Simone, J. L., & Jorge, W. A. (2013). Assessment of preemptive analgesia with ibuprofen coadministered or not with dexamethasone in third molar surgery: a randomized double-blind controlled clinical trial. Oral and maxillofacial surgery, 17(3), 165–171.

Brignardello-Petersen R. (2017). Submucosal dexamethasone reduces pain, swelling, and trismus after impacted third-molar extraction. Journal of the American Dental Association (1939), 148(5), e64.

Cashman J. N. (1996). The mechanisms of action of NSAIDs in analgesia. Drugs, 52 Suppl 5, 13–23.

Coleman, K., Norris, S., Weston, A., Grimmer-Sommers, K., Hillier, S., & Merlin, T. (2015). HMRC additional levels of evidence and grades for recommendations for developers of guidelines. NHMRC. Retrieved 26 August 2020, from http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/stage_2_consultation_levels_and_grades.pdf.

Costa, F., Soares, E., Esses, D., Silva, P., Bezerra, T., & Scarparo, H. et al. (2015). A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120mg on inflammatory events following removal of unerupted mandibular third molars. International Journal Of Oral And Maxillofacial Surgery, 44(9), 1166-1174.

Darawade, D. A., Kumar, S., Mehta, R., Sharma, A. R., & Reddy, G. S. (2014). In search of a better option: dexamethasone versus methylprednisolone in third molar impaction surgery. Journal of international oral health : JIOH, 6(6), 14–17.

Dionne, R. A., Gordon, S. M., Rowan, J., Kent, A., & Brahim, J. S. (2003). Dexamethasone suppresses peripheral prostanoid levels without analgesia in a clinical model of acute inflammation. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 61(9), 997–1003.

Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in medicine, 21(11), 1539–1558.

Laureano Filho, J. R., Maurette, P. E., Allais, M., Cotinho, M., & Fernandes, C. (2008). Clinical comparative study of the effectiveness of two dosages of Dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Medicina oral, patologia oral y cirugia bucal, 13(2), E129–E132.

Mojsa, I. M., Stypulkowska, J., Novak, P., Lipczynski, K., Szczeklik, K., & Zaleska, M. (2017). Pre-emptive analgesic effect of lornoxicam in mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. International journal of oral and maxillofacial surgery, 46(5), 614–620.

Moore, P. A., Brar, P., Smiga, E. R., & Costello, B. J. (2005). Preemptive rofecoxib and dexamethasone for prevention of pain and trismus following third molar surgery *. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 99(2), E1–E7.

Ong, K., Seymour, R., Chen, F., & Ho, V. (2004). Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain. International Journal Of Oral And Maxillofacial Surgery, 33(8), 771-776.

Paiva-Oliveira, J. G., Bastos, P. R., Cury Pontes, E. R., da Silva, J. C., Delgado, J. A., & Oshiro-Filho, N. T. (2016). Comparison of the anti-inflammatory effect of dexamethasone and ketorolac in the extractions of third molars. Oral and maxillofacial surgery, 20(2), 123–133.

Pereira, A.S.; Shitsuka, D.M.; Parreira, F.J. & Shitsuka, R. (2018). Metodologia da pesquisa científica. Editora UAB/NTE/UFSM, Santa Maria/RS. Acessed in 14 of September, 2020, at <https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1>.

Simone, J. L., Jorge, W. A., Horliana, A. C., Canaval, T. G., & Tortamano, I. P. (2013). Comparative analysis of preemptive analgesic effect of dexamethasone and diclofenac following third molar surgery. Brazilian oral research, 27(3), 266–271.

Sisk, A. L., & Bonnington, G. J. (1985). Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response. Oral surgery, oral medicine, and oral pathology, 60(2), 137–145.

Troullos, E. S., Hargreaves, K. M., Butler, D. P., & Dionne, R. A. (1990). Comparison of nonsteroidal anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and placebo for acute pain, swelling, and trismus. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 48(9), 945–952.

Published

14/09/2020

How to Cite

Momesso, G. A. C. ., Lemos, C. A. A., Lima, V. N. de ., Delanora, L. A., Santiago-Júnior, J. F. ., Faverani, L. P. ., & Pellizzer, E. P. . (2020). Is the combination of corticosteroids plus NSAIDs improve the preemptive analgesia after third molars surgery? A systematic review and meta-analysis. Research, Society and Development, 9(9), e968997979. https://doi.org/10.33448/rsd-v9i9.7979

Issue

Section

Health Sciences