Preoperative oral medication of combination of ibuprofen and dexamethasone can improve the anesthetic success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis
Editorial Commentary

布洛芬联合地塞米松口服预处理可增加下颌磨牙症状性不可复性牙髓炎的下牙槽神经阻滞成功率

Vivek Aggarwal1,2

1Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India; 2Sree Balaji Dental College, Chennai, India

Correspondence to: Vivek Aggarwal, MDS. Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi 110025, India. Email: drvivekaggarwal@gmail.com.

Comment on: Kumar M, Singla R, Gill GS, et al. Evaluating Combined Effect of Oral Premedication with Ibuprofen and Dexamethasone on Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial. J Endod 2021;47:705-10.

Received: 25 October 2021; Accepted: 10 November 2021; Published: 31 March 2022.

doi: 10.21037/joma-21-11

我很荣幸能够为《评估布洛芬联合地塞米松口服预处理对下颌磨牙症状性不可复性牙髓炎的下牙槽神经阻滞成功率的联合影响：一项前瞻性、双盲、随机临床试验》（Evaluating Combined Effect of Oral Premedication with Ibuprofen and Dexamethasone on Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial）撰写编辑评论。这篇文章发表于2021年5月的《牙髓病学杂志》（Journal of Endodontics）[1]。文章的作者中，有一位是我的友人（Rakesh Singla）。该文章评估了对症状性不可复性牙髓炎（symptomatic irreversible pulpitis, SIP）患者的下颌磨牙进行牙髓治疗时，口服药物预处理对下牙槽神经阻滞（inferior alveolar nerve block，IANB）成功率的影响。

下颌磨牙牙髓发炎，常常给临床医生带来挑战。过去十年，大量牙髓学文献都致力于提高下颌骨麻醉的成功率。提高IANB成功率的一个可行方案（也有大量报道）是在术前给予一定剂量的非甾体抗炎药物（Nonsteroidal Antiinflammatory Drugs）。然而这些文献的结果却有着矛盾之处。我们之前在一篇文章中报道过，术前口服布洛芬或酮咯酸并不能明显影响SIP患者IANB的成功率[2]。部分临床试验也报道了类似的证据[1,3-6]。但是也有另外一些试验支持术前预防性用药[7-9]。最近一篇（基于13项随机对照试验的）系统综述和荟萃分析指出，NSAIDs和布洛芬（＞400mg/天）提高了SIP患者IANB麻醉的成功率[10]。

在本文中，94例患者根据术前用药的类型被分为4组，分别为安慰剂、0.5mg地塞米松、800mg布洛芬、0.5mg地塞米松联合800mg布洛芬。患者接受2%利多卡因与1:200 000肾上腺素的IANB。尝试进行根管治疗和根管器械治疗。麻醉成功的定义为HPVAS（Heft Parker视觉模拟评分）疼痛评分<55分。失败的病例通过重复IANB、骨内、韧带内或髓内注射进行处理。本文数据表明，单独使用800mg布洛芬或0.5mg地塞米松在统计学上的结果与安慰剂相似。两种药物联合使用的效果明显更好。本研究的另一个重要发现是安慰剂组的成功率很高，达到75%，而在大多数关于下颌磨牙SIP的文献中，安慰剂成功率最高为40%～50%[5,11-13]。

本研究结果表明，单纯口服布洛芬或地塞米松可能无法提高IANB的成功率。应该注意的是，布洛芬组中，85%的SIP病例麻醉成功，这与其他临床研究中使用骨内注射的成功率相当[14]。作者采用的方法与以前处理SIP患者的研究相似[11]。SIP的诊断基于患者对电浆敏感性试验和热试验的反应。本研究的局限性之一是样本量有限（每组20～23例患者）。作者的结论是，术前布洛芬和地塞米松的联合使用可显著提高下颌磨牙SIP患者的IANB成功率。作者进一步建议今后应进行大样本量的试验。这让我们回到了同一个问题：在对SIP患者开始牙髓治疗之前，是否应该进行口服NSAIDs预处理？

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Oral and Maxillofacial Anesthesia. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://joma.amegroups.com/article/view/10.21037/joma-21-11/coif). The author has no conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Kumar M, Singla R, Gill GS, et al. Evaluating Combined Effect of Oral Premedication with Ibuprofen and Dexamethasone on Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial. J Endod 2021;47:705-10. [Crossref] [PubMed]
  2. Aggarwal V, Singla M, Kabi D. Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod 2010;36:375-8. [Crossref] [PubMed]
  3. Oleson M, Drum M, Reader A, et al. Effect of preoperative ibuprofen on the success of the inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 2010;36:379-82. [Crossref] [PubMed]
  4. Paul J, Ittyerah A, Kumar S. Effect of preoperative aceclofenac on the success of inferior alveolar nerve block in patients with irreversible pulpitis. Indian J Dent Sci 2011;3:171-4.
  5. Shahi S, Mokhtari H, Rahimi S, et al. Effect of premedication with ibuprofen and dexamethasone on success rate of inferior alveolar nerve block for teeth with asymptomatic irreversible pulpitis: a randomized clinical trial. J Endod 2013;39:160-2. [Crossref] [PubMed]
  6. Jena A, Shashirekha G. Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A placebo-controlled clinical study. J Conserv Dent 2013;16:171-4. [Crossref] [PubMed]
  7. Parirokh M, Ashouri R, Rekabi AR, et al. The effect of premedication with ibuprofen and indomethacin on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod 2010;36:1450-4. [Crossref] [PubMed]
  8. Wali A, Siddiqui TM, Qamar N, et al. Effectiveness of premedication with analgesics vs placebo for success of inferior alveolar nerve block in irreversible pulpitis. Int J Prosthodont Restor Dent 2012;2:5-9. [Crossref]
  9. Shantiaee Y, Javaheri S, Movahhedian A, et al. Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis. Int Dent J 2017;67:85-90. [Crossref] [PubMed]
  10. Nagendrababu V, Pulikkotil SJ, Veettil SK, et al. Effect of Nonsteroidal Anti-inflammatory Drug as an Oral Premedication on the Anesthetic Success of Inferior Alveolar Nerve Block in Treatment of Irreversible Pulpitis: A Systematic Review with Meta-analysis and Trial Sequential Analysis. J Endod 2018;44:914-922.e2. [Crossref] [PubMed]
  11. Claffey E, Reader A, Nusstein J, et al. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 2004;30:568-71. [Crossref] [PubMed]
  12. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics:. Mechanisms and Management. Endod Topics 2002;1:26-39. [Crossref]
  13. Bultema K, Fowler S, Drum M, et al. Pain Reduction in Untreated Symptomatic Irreversible Pulpitis Using Liposomal Bupivacaine (Exparel): A Prospective, Randomized, Double-blind Trial. J Endod 2016;42:1707-12. [Crossref] [PubMed]
  14. Bigby J, Reader A, Nusstein J, et al. Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis. J Endod 2006;32:1044-7. [Crossref] [PubMed]
译者简介
许欢
福建医科大学学士，现上海交通大学医学院附属第九人民医院住院医师。（更新时间：2022-03-31）
审校简介
郁葱
重庆医科大学附属口腔医院，医学博士，教授，主任医师，硕士生导师，德国Münster大学附属医院访问学者。重庆英才•创新领军人才。现任中华口腔医学会镇静镇痛专委会副主任委员，中华口腔医学会口腔麻醉学专委会副主任委员，中国心胸血管麻醉学会围术期基础与转化医学分会委员，中华医学会麻醉学分会五官科麻醉学组成员。从事口腔临床麻醉及无痛治疗专业工作22年。创新发展了无痛舒适口腔诊疗模式及技术体系，目前临床规模和影响力位居全国领先水平。承担多项国家卫生健康委员会、重庆市科委、重庆市卫健委科研课题；发表科研论文50余篇，含SCI收录论文14篇；主编著作2部，参编著作2部。以首席专家身份制定中华口腔医学会团体标准《儿童口腔门诊全身麻醉操作指南》，成立了以重庆医科大学附属口腔医院为主体单位的“舒适化口腔医疗专科联盟”，涵盖了全国50多家公立医疗机构。（更新时间：2022-05-25）

（本译文仅供学术交流，实际内容请以英文原文为准。）

doi: 10.21037/joma-21-11
Cite this article as: Aggarwal V. Preoperative oral medication of combination of ibuprofen and dexamethasone can improve the anesthetic success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Oral Maxillofac Anesth 2022;1:10.

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