Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis.
Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis.
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急性术后疼痛是由于成人人群的牙科提取而引起的：系统审查和网络荟萃分析。
DOI：
10.1177/00220345221139230
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发表时间：
2023-04
影响因子：
7.6
通讯作者：
中科院分区：
文献类型：
--
作者：
本研究比较了药物治疗的有效性，以制定治疗拔牙后急性疼痛的指导方针。我们于2020年11月21日检索了Medline、EMBASE、CENTRAL和US Clinical Trials registry。我们纳入了接受拔牙的受试者的随机临床试验（rct），比较了10种干预措施，包括对乙酰氨基酚、非甾体抗炎药（NSAIDs）、阿片类药物和安慰剂的组合。经过重复筛选和数据提取，我们对6小时的每个结果（即疼痛缓解、总疼痛缓解[TOTPAR]、总疼痛强度差[SPID]、总体疗效评分、抢救性镇痛和不良反应）进行了频率网络meta分析。我们使用改进的Cochrane RoB 2.0工具评估偏倚风险，使用分级推荐、评估、发展和评价方法评估证据的确定性。我们在RStudio 3.5.3版本中实现了分析，并将干预措施从最有利到最不利进行了分类。我们纳入了82项随机对照试验。56项纳入9095名参与者的随机对照试验发现，中度和高确定性证据表明，布洛芬200 - 400毫克加对乙酰氨基酚500 - 1000毫克（与安慰剂的平均差异[MDp]， 1.68； 95%可信区间[CI]， 1.06-2.31）、对乙酰氨基酚650毫克加羟考酮10毫克（MDp, 1.19; 95% CI, 0.85-1.54）、布洛芬400毫克（MDp, 1.31; 95% CI, 1.17-1.45）和萘普森400 - 440毫克（MDp, 1.44; 95% CI, 1.07-1.80）在0 - 4级评分中最有效缓解疼痛。羟考酮5毫克，可待因60毫克，曲马多37.5毫克加对乙酰氨基酚325毫克并不比安慰剂好。TOTPAR、SPID、总体疗效评分和抢救镇痛的结果相似。基于低确定性和极低确定性的证据，大多数干预措施在大多数不良反应方面被归类为不比安慰剂更有害。基于中等和高确定性的证据，非甾体抗炎药加或不加对乙酰氨基酚比阿片类药物加或不加对乙酰氨基酚（对乙酰氨基酚650 mg加羟考酮10 mg除外）或安慰剂的疼痛相关结果更好。
This study compares the effectiveness of pharmacological treatments to develop guidelines for the management of acute pain after tooth extraction. We searched Medline, EMBASE, CENTRAL, and US Clinical Trials registry on November 21, 2020. We included randomized clinical trials (RCTs) of participants undergoing dental extractions comparing 10 interventions, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations to placebo. After duplicate screening and data abstraction, we conducted a frequentist network meta-analysis for each outcome at 6 h (i.e., pain relief, total pain relief [TOTPAR], summed pain intensity difference [SPID], global efficacy rating, rescue analgesia, and adverse effects). We assessed the risk of bias using a modified Cochrane RoB 2.0 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We implemented the analyses in RStudio version 3.5.3 and classified interventions from most to least beneficial or harmful. We included 82 RCTs. Fifty-six RCTs enrolling 9,095 participants found moderate- and high-certainty evidence that ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg (mean difference compared to placebo [MDp], 1.68; 95% confidence interval [CI], 1.06–2.31), acetaminophen 650 mg plus oxycodone 10 mg (MDp, 1.19; 95% CI, 0.85–1.54), ibuprofen 400 mg (MDp, 1.31; 95% CI, 1.17–1.45), and naproxen 400–440 mg (MDp, 1.44; 95% CI, 1.07–1.80) were most effective for pain relief on a 0 to 4 scale. Oxycodone 5 mg, codeine 60 mg, and tramadol 37.5 mg plus acetaminophen 325 mg were no better than placebo. The results for TOTPAR, SPID, global efficacy rating, and rescue analgesia were similar. Based on low- and very low-certainty evidence, most interventions were classified as no more harmful than placebo for most adverse effects. Based on moderate- and high-certainty evidence, NSAIDs with or without acetaminophen result in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo.
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影响因子：
105.7
作者：
Brignardello-Petersen, Romina;Izcovich, Ariel;Schunemann, Holger J.
通讯作者：
Schunemann, Holger J.
影响因子：
39.2
作者：
Hutton, Brian;Salanti, Georgia;Moher, David
通讯作者：
Moher, David
影响因子：
7.2
作者：
Brignardello-Petersen, Romina;Mustafa, Reem A.;Guyatt, Gordon H.
通讯作者：
Guyatt, Gordon H.
影响因子：
8.4
作者：
Moore, R. Andrew;Derry, Sheena;McQuay, Henry J.;Wiffen, Philip J.
通讯作者：
Wiffen, Philip J.
DOI：
10.14219/jada.archive.2013.0207
发表时间：
2013-08-01
影响因子：
3.9
作者：
Moore, Paul A.;Hersh, Elliot V.
通讯作者：
Hersh, Elliot V.