Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials

Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials

This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRIS...

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Published in:Inflammopharmacology Vol. 31; no. 4; pp. 1561 - 1575
Main Authors: Cetira-Filho, Edson Luiz, Martins-Filho, Paulo Ricardo, de Barros Silva, Paulo Goberlânio, da Hora Sales, Pedro Henrique, Vieira, Alessandra Fragoso, Sindeaux, Lívia Maria Eugênio, dos Anjos, Mayara Oliveira, Leão, Jair Carneiro, Costa, Fábio Wildson Gurgel
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-08-2023
Subjects:
Allergology
Biomedical and Life Sciences
Biomedicine
Dermatology
Gastroenterology
Immunology
Pharmacology/Toxicology
Review
Rheumatology
Coadministration
Third molar surgery
Anti-inflammatory drugs
Preemptive analgesia
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Summary:This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane’s Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12 h postoperatively) and swelling (48 h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24 h follow-up; swelling and trismus intensity ameliorated at 48 h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.
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ISSN:0925-4692
1568-5608
DOI:10.1007/s10787-023-01258-1