DOES THE PRE-ANAESTHETIC MEDICATION IMPROVE THE ANALGESIA OF MANDIBULAR MOLARS WITH IRREVERSIBLE PULPITIS? AN UMBRELLA REVIEW

Abstract

Determine whether the use of premedication increase the anaesthetic efficacy of the inferior alveolar nerve in teeth with symptomatic irreversible pulpitis, through the review question: Does the use of premedication increase the efficacy of the anaesthetic technique of inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?. Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anaesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were systematically searched in six electronic databases (MEDLINE/PubMed, Scoupus, Web of Science, Cochrane Library, EMBASE and Open Grey), without restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. Twelve systematic reviews were included. Only one did not performed meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high quality. The main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with paracetamol, and ketorolac) increased the success of the inferior alveolar nerve block. From the ‘very low’ to ‘high’ quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenases pathways and block the synthesis of specific prostaglandins that difficult the mechanism of action of the anaesthesia, increasing the success rate of the anaesthetic technique of inferior alveolar nerve block efficacy in cases of mandibular molars with symptomatic irreversible pulpitis.