Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis

Fernandes, Ighor Andrade; Souza, Glaciele Maria de; Pinheiro, Marcos Luciano Pimenta; Falci, Saulo Gabriel Moreira

doi:10.1016/j.ijom.2018.09.014

Cited by 30 publications

(18 citation statements)

References 27 publications

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“…Inhibition of phospholipase A2 reduces arachidonic acid release, decreasing the levels of vasoactive substances: prostaglandins and leukotrienes. 4,6 These results differ with Al-Shamiri et al, 25 as their study showed that preoperative dexamethasone medication increased its analgesic effect, according to the VAS, and achieved significantly higher efficacy on the third day (2.6mm ± 1.5mm), compared to the group that received postoperative dexamethasone (3.2mm ± 1.5mm); p=0.008. Similarly, Boonsiriseth et al, 28 reported a similar analgesic effect on the first day after immediate post-surgical administration of intramuscular (20.8mm ± 21.3mm) and oral (22.4mm ± 24mm) dexamethasone, increasing progressively until the seventh postoperative day (2.2mm ± 5.5mm and 4.7mm ± 1.21mm; respectively); p>0.05.…”

Section: Discussionmentioning

confidence: 70%

“…On the other hand, in their systematic review, Fernandes et al, 4 found no difference in swelling between preoperative and immediate postoperative administration of dexamethasone. A reason for this could be that the studies included used different administration routes (oral, intramuscular and submucosal).…”

Section: Discussionmentioning

confidence: 87%

“…In addition, the intramuscular route was chosen for its accessibility, fast acting capabilities and greater control of the inflammatory process in mandibular third molar surgery. [3][4][5]16 The surgical difficulty index and the duration of the procedure are related to each other and, in turn, to surgical trauma, favoring the postoperative inflammatory process. 13,14 In this research, there was no significant difference in the surgical difficulty index between both groups, meaning these parameters did not affect the results.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, there is a great release of inflammatory mediators such as histamine, bradykinin and prostaglandins, intensifying the inflammatory process. [3][4][5][6] The most frequent postoperative complications are edema, trismus (a consequence of the swelling and contracture of masticatory muscles) and pain. These complications lead to an uncomfortable situation for the patient, hindering or even impeding daily activities.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 If the patient does not accept the parenteral route for corticosteroid administration, the oral route is an option. 4 The literature recommends 8mg dexamethasone, 1 hour before the surgical procedure. 10,11 These protocols are based on numerous clinical trials; however, there is insufficient scientific evidence to reach a consensus regarding the anti-inflammatory effectiveness of dexamethasone in mandibular third molar surgery, when using the same dose and route at different administration times.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: A randomized clinical trial.

et al. 2020

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Objective: To compare the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery. Materials and methods: Randomized clinical trial conducted in 60 patients in need of mandibular third molar extraction, ages ranging from 16 to 35 years old, at the Department of Oral and Maxillofacial Surgery of the Arzobispo Loayza National Hospital during the period of January-March, 2016. Patients were distributed in two randomized groups: Group A received 4mg dexamethasone intramuscular before the surgery, and Group B received the same medication post-surgery. Facial edema was assessed using the distance between facial points, trismus was evaluated using the interincisal distance, and pain intensity was determined using a Numerical Scale (NS). Results: Facial edema values were lower in Group A at 60 minutes (p=0.002) and after the first (p=0.001) and third days (p=0.009), compared to Group B. Regarding trismus, no significant differences between the groups were found. Regarding pain intensity, the highest point was recorded at 6 hours in both groups; however, no significant differences between the groups were found. Conclusion: Pre-surgical dexamethasone administration produced a significantly greater reduction in facial edema after mandibular third molar surgery.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: A randomized clinical trial.

et al. 2020

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Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

et al. 2020

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Objectives To assess and compare the pharmacological effect of different drugs on pain relief after periodontal surgery. Materials and methods Five databases were searched up to September 2019. The eligible studies comprised randomized clinical trials, involving only adult individuals that received any periodontal surgery and presenting two distinct groups of therapeutic regimens to control postoperative pain. Placebo groups could be included. The risk of bias was assessed with the RoB 2 Cochrane tool and the GRADE system. Meta-analyses were performed using different follow-up and drug comparisons. Results Overall, 2398 studies were identified, of which 35 were included. Low risk of bias was determined for the majority of the studies. The meta-analyses showed that the comparison of dexamethasone or non-steroidal anti-inflammatory drugs (NSAID) versus placebo favored the use of both interventions in a follow-up of 1 to 8 h for open flap procedures (OFP). However, no statistical difference was found for the comparison between NSAID and dexamethasone for OFP. Conclusions Patients may benefit from several pharmacological schemes for pain relief after periodontal surgeries. However, due to the high heterogeneity among studies, no fixed pharmacological protocol could be proposed. Clinical relevance There is not enough evidence to recommend one therapeutic scheme. However, untreated pain is harmful to the patients and it is not advisable.

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Comparison of preemptive etoricoxib and dexamethasone in third molar surgery – a randomized controlled clinical trial of patient-reported and clinical outcomes

et al. 2023

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Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis

Cited by 30 publications

References 27 publications

Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: A randomized clinical trial.

Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: A randomized clinical trial.

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

Comparison of preemptive etoricoxib and dexamethasone in third molar surgery – a randomized controlled clinical trial of patient-reported and clinical outcomes

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