Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis

Sivaramakrishnan, Gowri; Sridharan, Kannan

doi:10.2174/1874210601812010340

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…3 Sivaramakrishnan et al concluded in their study that oral ketorolac can be successfully administered as a premedication before conventional inferior alveolar nerve block for endodontic treatment for irreversible pulpitis. 19 Our study also correlated with Vieyra et al who concluded that oral ketorolac was as safe and effective for postoperative pain relief in patients with symptomatic apical periodontitis. 20 Our study is contradictory to the study by de Geus et al who concluded that ibuprofen premedication is beneficial for the success of inferior alveolar nerve block in patients with irreversible pulpitis.…”

Section: Brief History Of Nsaidssupporting

confidence: 87%

Evaluation of NSAIDs in Acute Odontogenic Pain: A Quadriblind Study

Mohan¹,

Narayanan²,

Ravikumar³

et al. 2019

World Journal of Dentistry

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Odontogenic pain refers to pain arising from the teeth or their supporting structures, the oral mucous membrane, the maxilla or mandible, or periodontal ligament membrane. Management of odontogenic pain becomes challenging in the modern era to the clinician due to its diversified etiologies. Aim: The primary aim is to evaluate the efficacy of NSAIDs in treating acute odontogenic pain due to acute pulpitis, acute periapical abscess, and acute pain after root canal therapy. Materials and methods: Patients visiting the outpatient department, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation, with odontogenic pain due to acute pulpitis and acute periapical abscess were randomly selected. A total of 80 patients were considered and divided into 4 groups (n = 20 were prescribed paracetamol, n = 20 were prescribed ibuprofen, n = 20 were prescribed aceclofenac, n = 20 were prescribed ketorolac). The patients in each group were not aware of the analgesic drug prescribed. (quadriblind drug trial). Pain was analyzed by the visual analog score (VAS) graded from 0 to 10, and the VAS scores were recorded at initial, 30-minutes, 1-hour, and 2-hours intervals. Result: Ketorolac is better in relieving the odontogenic pain when compared to paracetamol, ibuprofen, and aceclofenac. Conclusion: Ketorolac is an effective NSAID in relieving the odontogenic pain. Clinical significance: This study helps to evaluate the effectiveness of nonsteroidal anti-inflammatory drugs for odontogenic pain and helps in identifying the more potent NSAID for odontogenic pain without the use of inferior alveolar nerve block.

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Section: Brief History Of Nsaidssupporting

confidence: 87%

Evaluation of NSAIDs in Acute Odontogenic Pain: A Quadriblind Study

Mohan¹,

Narayanan²,

Ravikumar³

et al. 2019

World Journal of Dentistry

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“…Also combined compositions of thin films were selected, which based on the same polymers with addition of Carbopol ® 971P NF in concentration of 0.05 % (▶Table 1). There were added 0.02 g ketorolac trometamine to produce the thin film covering 78.5 cm 2 at 25 ml of purified water, concentration of ketorolac is equivalent to the recommended effective single-dose [6,7].…”

Section: Resultsmentioning

confidence: 99%

“…has shown the effectiveness in the treatment of inflammation in oral cavity and sharp pain, when it was administered orally, buccally, parenterally and intranasally [7][8][9]. However, using the ketorolac trometamine in such dosage form as a dental film will allow providing targeted treatment of the affected areas, as well as to modify release and correct the intensity of the side effects.…”

Section: Development Of Composition and Technologies Of Dental Film Wmentioning

confidence: 99%

Development of Composition and Technologies of Dental Film with Ketorolac Trometamine

et al. 2020

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The report presents the results of the development of dental films with ketorolac trometamine based on the natural biodegradable polymers from the groups of sodium alginates and xanthan gums in combination with lightly crosslinked acrylic polymer carbopol. Physicochemical properties, such as moisture, mucoadhesion, thickness, tensile strength, disintegration in phosphate buffer were determined in obtained samples of this dosage form. A comparison of physicochemical properties of experimental samples and commercial model of dental film has allowed establishing the perspective composition of complex matrix of films with ketorolac trometamine for use in dentistry.

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“…Several systematic reviews and meta‐analyses have been carried out to introduce the techniques for enhancing the efficacy of IANBs, particularly for irreversible pulpitis (Larocca de Geus et al, 2020; Nagendrababu et al, 2021; Pulikkotil et al, 2018; Tupyota et al, 2018; Zanjir et al, 2019). Previous meta‐analyses reported that increasing the volume of the anaesthetic solution (Nagendrababu et al, 2021; Tupyota et al, 2018), choosing articaine (Larocca de Geus et al, 2020) or mepivacaine (Nagendrababu et al, 2019) as an anaesthetic solution, and using oral premedication (Tupyota et al, 2018) such as ibuprofen (Nagendrababuet al, 2018), ketorolac (Sivaramakrishnan & Sridharan, 2018), and tramadol (Pulikkotil et al, 2018), increase the success rate of IANB. Supplemental injection, particularly intraosseous, and buccal and lingual infiltrations with articaine, also increases the efficacy of IANB (Zanjir et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta‐analysis and trial sequential analysis

et al. 2022

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Background: Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. Objectives: To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). Methods: Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16.The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. Results:Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I 2 = 98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR = 1.24; 95% CI: 1.15-1.34; I 2 = 7.16%).In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR = 1.22; 95% CI: 0.98-1.52; I 2 = 0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR = 1.76; 95% CI: 0.93-3.32; I 2 = 18.41% and RR = 1.06; 95% CI: 0.65-1.72; I 2 = 53.5%, respectively).Discussion: TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively.

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Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis

Cited by 10 publications

References 25 publications

Evaluation of NSAIDs in Acute Odontogenic Pain: A Quadriblind Study

Evaluation of NSAIDs in Acute Odontogenic Pain: A Quadriblind Study

Development of Composition and Technologies of Dental Film with Ketorolac Trometamine

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta‐analysis and trial sequential analysis

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