Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis

doi:10.1007/s00784-020-03675-w

Meta-Analysis

. 2021 Jan;25(1):1-22.

doi: 10.1007/s00784-020-03675-w. Epub 2020 Nov 8.

Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis

Affiliations

¹ Postgraduate Program in Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil.
² Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.
³ School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
⁴ Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, UNICAMP, Piracicaba, Brazil.
⁵ Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
⁶ Residency Training in Oral and Maxillofacial Surgery, School of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
⁷ Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Campus Umuarama, Av. Pará, 1720, Bloco 2G, sala 1, Uberlândia, Minas Gerais, 38405-320, Brazil. paranhos.lrp@gmail.com.
⁸ College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

PMID: 33161499
DOI: 10.1007/s00784-020-03675-w

Meta-Analysis

Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis

Marco Tulio Rossi et al. Clin Oral Investig. 2021 Jan.

. 2021 Jan;25(1):1-22.

doi: 10.1007/s00784-020-03675-w. Epub 2020 Nov 8.

Affiliations

¹ Postgraduate Program in Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil.
² Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.
³ School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
⁴ Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, UNICAMP, Piracicaba, Brazil.
⁵ Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
⁶ Residency Training in Oral and Maxillofacial Surgery, School of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
⁷ Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Campus Umuarama, Av. Pará, 1720, Bloco 2G, sala 1, Uberlândia, Minas Gerais, 38405-320, Brazil. paranhos.lrp@gmail.com.
⁸ College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

PMID: 33161499
DOI: 10.1007/s00784-020-03675-w

Abstract

Objective: To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars.

Methods: Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The "JBI Critical Appraisal Tools for Systematic Reviews" was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence.

Results: The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = - 1.44; - 2.72 to - 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = - 1.36; - 2.13 to - 0.59). The certainty of evidence varied between very low to moderate.

Conclusion: 2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars.

Clinical significance: The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.

Keywords: Anesthetics; Oral surgery; Systematic review; Third molar.

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Injectable and topical local anesthetics for acute dental pain: 2 systematic reviews.
Miroshnychenko A, Ibrahim S, Azab M, Roldan Y, Diaz Martinez JP, Tamilselvan D, He L, Urquhart O, Tampi M, Polk DE, Moore PA, Hersh EV, Carrasco-Labra A, Brignardello-Petersen R. Miroshnychenko A, et al. J Am Dent Assoc. 2023 Jan;154(1):53-64.e14. doi: 10.1016/j.adaj.2022.10.014. J Am Dent Assoc. 2023. PMID: 36608963 Free PMC article. Review.

References

1. Ogle OE, Mahjoubi G (2012) Local anesthesia: agents, techniques, and complications. Dent Clin N Am 56:133–148. https://doi.org/10.1016/j.cden.2011.08.003 - DOI - PubMed
1. Bouloux GF, Punnia-Moorthy A (1999) Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg 57:510–514. https://doi.org/10.1016/s0278-2391(99)90063-0 - DOI - PubMed
1. Kambalimath DH, Dolas RS, Kambalimath HV, Agrawal SM (2013) Efficacy of 4% articaine and 2% lidocaine: a clinical study. J Maxillofac Oral Surg 12:3–10. https://doi.org/10.1007/s12663-012-0368-4 - DOI - PubMed
1. Olmedo-Gaya MV, Manzano-Moreno FJ, Muñoz-López JL, Vallecillo-Capilla MF, Reyes-Botella C (2018) Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction. Clin Oral Investig 22:2981–2988. https://doi.org/10.1007/s00784-018-2386-1 - DOI - PubMed
1. Earl P (1994) Patients’ anxieties with third molar surgery. Br J Oral Maxillofac Surg 32:293–297. https://doi.org/10.1016/0266-4356(94)90049-3 - DOI - PubMed

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[1] Ogle OE, Mahjoubi G (2012) Local anesthesia: agents, techniques, and complications. Dent Clin N Am 56:133–148. https://doi.org/10.1016/j.cden.2011.08.003 - DOI - PubMed

[2] Ogle OE, Mahjoubi G (2012) Local anesthesia: agents, techniques, and complications. Dent Clin N Am 56:133–148. https://doi.org/10.1016/j.cden.2011.08.003 - DOI - PubMed

[3] Bouloux GF, Punnia-Moorthy A (1999) Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg 57:510–514. https://doi.org/10.1016/s0278-2391(99)90063-0 - DOI - PubMed

[4] Bouloux GF, Punnia-Moorthy A (1999) Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg 57:510–514. https://doi.org/10.1016/s0278-2391(99)90063-0 - DOI - PubMed

[5] Kambalimath DH, Dolas RS, Kambalimath HV, Agrawal SM (2013) Efficacy of 4% articaine and 2% lidocaine: a clinical study. J Maxillofac Oral Surg 12:3–10. https://doi.org/10.1007/s12663-012-0368-4 - DOI - PubMed

[6] Kambalimath DH, Dolas RS, Kambalimath HV, Agrawal SM (2013) Efficacy of 4% articaine and 2% lidocaine: a clinical study. J Maxillofac Oral Surg 12:3–10. https://doi.org/10.1007/s12663-012-0368-4 - DOI - PubMed

[7] Olmedo-Gaya MV, Manzano-Moreno FJ, Muñoz-López JL, Vallecillo-Capilla MF, Reyes-Botella C (2018) Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction. Clin Oral Investig 22:2981–2988. https://doi.org/10.1007/s00784-018-2386-1 - DOI - PubMed

[8] Olmedo-Gaya MV, Manzano-Moreno FJ, Muñoz-López JL, Vallecillo-Capilla MF, Reyes-Botella C (2018) Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction. Clin Oral Investig 22:2981–2988. https://doi.org/10.1007/s00784-018-2386-1 - DOI - PubMed

[9] Earl P (1994) Patients’ anxieties with third molar surgery. Br J Oral Maxillofac Surg 32:293–297. https://doi.org/10.1016/0266-4356(94)90049-3 - DOI - PubMed

[10] Earl P (1994) Patients’ anxieties with third molar surgery. Br J Oral Maxillofac Surg 32:293–297. https://doi.org/10.1016/0266-4356(94)90049-3 - DOI - PubMed

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Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis

Affiliations

Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis

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Abstract

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