Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of
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REVIEW
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 1 & Murilo Navarro de Oliveira 2 & Maria Tereza Campos Vidigal 3 & Walbert de Andrade Vieira 4 & Cristiano Elias Figueiredo 2 & Cauane Blumenberg 5 & Vinicius Lima de Almeida 6 & Luiz Renato Paranhos 7 & Luciana Butini Oliveira 1 & Walter Luiz Siqueira 8 & Rui Barbosa de Brito Júnior 1 Received: 22 September 2020 / Accepted: 29 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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
* Luiz Renato Paranhos [email protected] 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,
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