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Effect of preoperative oral analgesics on pulpal anesthesia in patients with irreversible pulpitis—a systematic review and meta-analysis

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Abstract

Objectives

The objectives of this study were to assess the efficacy of preemptive oral administration of single dose of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on the local anesthetic success in adults with irreversible pulpitis and to find the possible covariates that could predict treatment effect.

Materials and methods

A systematic search using electronic databases up to March 2015 was conducted. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated using random and fixed-effect inverse variance method. Subgroup and meta-regression analyses were conducted to assess the potential source of heterogeneity.

Results

Results showed that preemptive analgesics are more effective than placebo in increasing anesthetic success (OR = 0.30, CI% 0.24–0.39, p = 0.000) [Q = 55.860 (p = 0.001)]. In the subgroup analysis, administration of NSAIDs as monotherapy, ibuprofen as mono- vs. combination therapy, oxicam type drugs as monotherapy, and acetaminophen as combination therapy were significantly more effective in increasing anesthetic success OR = 0.25, CI% 0.16–0.38, p = 0.00, Q = 40.539 (p = 0.003); OR = 0.44, CI% 0.26–0.75, p = 0.00, Q = 12.833 (p = 0.011); OR = 0.48, CI% 0.30–0.74, p = 0.002, Q = 15.898 (p = 0.14); OR = 0.30, CI% 0.16–0.38, p = 0.001, Q = 7.506 (p = 0.02); OR = 0.10, CI% 0.16 0.38, p = 0.001, Q = 5.075 (p = 0.07), respectively. However, there was no significant difference in increasing anesthetic success between treatment and placebo arms when acetaminophen was administrated alone. In meta-regression analysis, an association between different types of NSAIDs (indomethacin, diclofenac potassium, and oxicam-type drugs) and articaine with treatment effect was observed.

Conclusions

The administration of preemptive analgesics can induce superior intraoperative analgesia for patients with irreversible pulpitis. However, strategies such as co-administration of certain types of analgesics and anesthetic solution might be predictors of treatment effect. Additionally, there was no association between different timing and dosage of analgesics and treatment effect.

Clinical relevance

When compared to placebo, preemptive oral analgesics are superior in achieving anesthetic success in inflamed pulp.

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Acknowledgments

The authors deny any conflicts of interest.

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Authors and Affiliations

  1. Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran

    Armin Shirvani & Saeed Asgary

  2. Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Evin, Tehran, 1983963113, Iran

    Sayna Shamszadeh, Mohammad Jafar Eghbal & Laleh Alim Marvasti

Authors
  1. Armin Shirvani
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  2. Sayna Shamszadeh
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  3. Mohammad Jafar Eghbal
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  4. Laleh Alim Marvasti
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  5. Saeed Asgary
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Correspondence to Sayna Shamszadeh.

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The authors declare that they have no conflict of interest.

Funding

The work was supported by the Iranian Center for Endodontic Research, Research Institute of Dental Science of Shahid Beheshti Medical University in Tehran, Iran.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Shirvani, A., Shamszadeh, S., Eghbal, M.J. et al. Effect of preoperative oral analgesics on pulpal anesthesia in patients with irreversible pulpitis—a systematic review and meta-analysis. Clin Oral Invest 21, 43–52 (2017). https://doi.org/10.1007/s00784-016-1974-1

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  • DOI: https://doi.org/10.1007/s00784-016-1974-1

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