Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis
- PDF / 769,247 Bytes
- 20 Pages / 595.276 x 790.866 pts Page_size
- 79 Downloads / 201 Views
ORIGINAL ARTICLE
Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis Fan Yang 1 & Yuxuan Gao 1 & Lan Zhang 1 & Bo Zheng 1,2 & Liu Wang 1 & Huan Sun 3 & Dingming Huang 1 Received: 20 November 2019 / Accepted: 31 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives Pain management for the extraction of the mandibular third molar is a challenge as compelling evidence in comparative anaesthetics is currently lacking. Materials and methods Thorough literature searches took place in PubMed, ScienceDirect, CENTRAL, Embase, Web of Science, CBM, and CNKI. Thirty-three trials were meta-analysed using a Bayesian statistical approach within the randomeffects model. Grading of Recommendations Assessment, Development, and Evaluation was performed to determine the overall quality of evidence across all comparisons. Results In terms of success rate, an inferior alveolar nerve block (IANB) injection of 2% lidocaine with epinephrine was less effective than a combined injection of buccal infiltration (BI) and lingual infiltration (LI) with a 4% articaine (RR = 0.85 [0.75, 0.96], P = 0.611). According to visual analogue scale (VAS), 2% lidocaine-IANB with epinephrine caused higher VAS scores than 4% articaine-IANB with epinephrine (MD = 0.84 [0.28, 1.40], P = 0.057), whereas 0.5% levobupivacaine-IANB showed lower scores than 2% lidocaine-IANB (MD = − 1.62 [− 2.97, − 0.28], P = 0.045). Also, 2% lidocaine-IANB with epinephrine presented longer latency than both 4% articaine-IANB with epinephrine (MD = 39.44 [16.97, 61.90], P < 0.001) and 4% articaine-BI + LI with epinephrine (MD = 164.41 [16.23, 312.58], P < 0.001); 4% articaine-IANB with epinephrine produced shorter latency than 0.5% bupivacaine-IANB with epinephrine (MD = − 42.92 [− 70.28, − 15.56], P = 0.106); 0.75% ropivacaine-IANB caused shorter onset of action compared with 2% lidocaine-IANB (MD = − 40.88 [− 65.50, − 16.26], P < 0.001). In addition, 2% lidocaine-IANB with epinephrine produced significantly shorter duration than both 4% articaine-IANB with epinephrine (MD = − 47.33 [− 57.88, − 36.77], P = 0.265) and 2% mepivacaine-IANB with epinephrine (MD = − 10.01 [− 19.59, − 0.44], P = 0.769). The duration of action triggered by 4% articaine-IANB with epinephrine was shorter compared with 0.5% bupivacaineIANB with epinephrine (MD = − 64.17 [− 74.65, − 53.69], P = 0.926). Both 0.5% levobupivacaine-IANB and 0.75% ropivacaine-IANB produced longer duration of action than 2% lidocaine-IANB (MD = 333.70 [267.33, 400.07], P < 0.001) and (MD = 288.01 [287.67, 288.34], P = 0.634, respectively). Conclusions The network meta-analysis demonstrated that the intraosseous injection of 4% articaine with epinephrine had the most noteworthy success rate. However, the combination of BI and LI of 4% articaine with epinephrine, and IANB of 0.5% bupivacaine were, according to a VAS, the most effective. It should be noted that a rapid onset of action was produced by BI
Fan Yang and Yuxuan Gao are c
Data Loading...
