Preemptive analgesia via oral route in mandibular third molar surgeries: a network meta-analysis

The present systematic review with network meta-analysis aimed to compare the performance of preemptive analgesia by oral route in drugs evaluated in randomized clinical trials, considering the outcomes: average consumption of analgesics, pain, edema and trismus in surgeries mandibular third molars. In addition, different types of drugs have been classified based on their performance. A systematic review was carried out based on the Cochrane and PRISMA guidelines. The quality of the evidence and the network meta-analysis were conducted using the GRADE tool and Software R, respectively. Five databases were searched, in addition to a manual search in the gray literature, and the articles were selected based on the PICOs strategy. A total of 5123 articles were found. Of these, thirty-seven articles were included. Nimesulide (100mg) was the best classified drug therapy (97.8%) in relation to the average consumption of analgesics, as well as at all postoperative times for the pain outcome: 6 hours (MD: -3.55, 95% CI: -4.87 to -2.23), 12 hours (MD: -3.95 CI95% -6.62 to -1.27) and 24 hours (MD: -1.85, 95% CI: -2.94 to -0.76). Dexamethasone (8mg) associated with Nimesulide (100mg) showed a greater reduction in edema and trismus after the 3rd postoperative day. On the 1st postoperative day, Ampiroxicam (27mg) had the lowest mean of trismus (MD: -6.30, 95% CI: -7.79 to -4.81). In conclusion, Nimesulide (100mg) proves to be the best medication for the control of postoperative pain. And its association with Dexamethasone (8mg) demonstrated the best results for the control of edema and trismus after the third postoperative day.