Non-Cochrane · intervention · PM42889447
Nonsteroidal anti-inflammatory drug (NSAID) premedication for pain-free inferior alveolar nerve block: a systematic review and meta-analysis.
Sabeti Mohammad A, Boroumand Tara, Masoumi Seyed Mohammadreza, et al. · Journal of dental anesthesia and pain medicine · 2026 · PubMed · doi:10.17245/jdapm.2026.26.122
Findings
11 findings
| Population | ||||
|---|---|---|---|---|
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Any oral NSAID before IANB | Oral placebo before IANB | Pain-free initial IANB success without supplemental anesthesia Intraoperative assessment, procedural steps vary by trial · Sensitivity: excluding high risk-of-bias trials | RR 2.28 [1.84, 2.82] GRADE not reported 7 studies · 576 participants |
| Adults with mandibular posterior teeth with symptomatic irreversible pulpitis undergoing endodontic treatment under inferior alveolar nerve block (IANB) | Oral NSAID premedication (any agent) + IANB | Oral placebo + IANB | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) Intraoperative, after initial IANB (access and/or instrumentation or pulp extirpation) · Endodontic treatment (clinical trials, dental settings) · Sensitivity: excluding Sharma et al. 2023 | RR 2.31 [1.89, 2.83] GRADE not reported 10 studies |
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Any oral NSAID before IANB | Oral placebo before IANB | Adverse events after premedication Intraoperative assessment, procedural steps vary by trial | no estimate extracted GRADE not reported 3 studies |
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Any oral NSAID before IANB | Oral placebo before IANB | Pain-free initial IANB success without supplemental anesthesia Intraoperative assessment, procedural steps vary by trial · Sensitivity: trials assessing pain beyond access | RR 2.27 [1.81, 2.85] GRADE not reported 6 studies · 510 participants |
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Any oral NSAID before IANB | Oral placebo before IANB | Pain-free initial IANB success without supplemental anesthesia Intraoperative assessment, procedural steps vary by trial | RR 2.06 [1.48, 2.86] 301 [136, 529] per 1000 Low Downgraded: risk of bias, inconsistency 11 studies · 737 participants |
| Adults with mandibular posterior teeth with symptomatic irreversible pulpitis undergoing endodontic treatment under inferior alveolar nerve block (IANB) | Oral NSAID premedication (any agent) + IANB | Oral placebo + IANB | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) Intraoperative, after initial IANB (access and/or instrumentation or pulp extirpation) · Endodontic treatment (clinical trials, dental settings) · Sensitivity: excluding Rodrigues et al. 2024 | RR 2.01 [1.44, 2.81] GRADE not reported 10 studies |
| Adults with mandibular posterior teeth with symptomatic irreversible pulpitis undergoing endodontic treatment under inferior alveolar nerve block (IANB) | Oral diclofenac 50 mg premedication + IANB | Oral placebo + IANB | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) Intraoperative, after initial IANB (access and/or instrumentation or pulp extirpation) · Endodontic treatment (clinical trials, dental settings) · NSAID agent: diclofenac; sensitivity: excluding Rodrigues et al. 2024 | RR 2.36 [0.78, 7.12] GRADE not reported 3 studies |
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Oral diclofenac 50 mg before IANB | Oral placebo before IANB | Pain-free initial IANB success without supplemental anesthesia Intraoperative assessment, procedural steps vary by trial | RR 2.44 [1.18, 5.03] 281 [35, 786] per 1000 Moderate Downgraded: imprecision 4 studies · 256 participants |
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Oral ketorolac 10 mg before IANB | Oral placebo before IANB | Pain-free initial IANB success without supplemental anesthesia Intraoperative assessment, procedural steps vary by trial | RR 2.39 [1.74, 3.27] 389 [207, 636] per 1000 Moderate Downgraded: risk of bias 5 studies · 250 participants |
| Adults with symptomatic irreversible pulpitis in permanent mandibular posterior teeth undergoing nonsurgical endodontic treatment under IANB | Oral ibuprofen 400–600 mg before IANB | Oral placebo before IANB | Pain-free initial IANB success without supplemental anesthesia Intraoperative assessment, procedural steps vary by trial | RR 1.53 [0.91, 2.58] 226 [-38, 574] per 1000 Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 202 participants |
| Adults with mandibular posterior teeth with symptomatic irreversible pulpitis undergoing endodontic treatment under inferior alveolar nerve block (IANB) | Oral ibuprofen 400-600 mg premedication + IANB | Oral placebo + IANB | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) Intraoperative, after initial IANB (access and/or instrumentation or pulp extirpation) · Endodontic treatment (clinical trials, dental settings) · NSAID agent: ibuprofen; sensitivity: excluding Sharma et al. 2023 | RR 1.97 [1.38, 2.81] GRADE not reported 4 studies |
Included primary studies 11
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Dehraj 2020 matched by author and year (probable) | NR | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Hegde 2023 Effect of Preoperative Oral Steroids in Comparison to Anti-inflammatory on Anesthetic Success of Inferior Alveolar Nerve Block in… PMID:36736586 | 2023 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Jena 2013 Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A… PMID:23716973 | 2013 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Kaur 2023 matched by author and year (probable) | NR | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Noguera-Gonzalez 2013 Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a… PMID:23561002 | 2013 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Prasanna 2011 The efficacy of pre-operative oral medication of lornoxicam and diclofenac potassium on the success of inferior alveolar nerve block in… PMID:21692235 | 2011 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Rodrigues 2024 Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade… PMID:38279778 | 2024 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Saha 2016 Effect of Oral Premedication on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A… PMID:27042580 | 2016 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Sharma 2023 Comparative evaluation of effect of different premedication agents on efficacy of Articaine: A randomized contol trial. PMID:36741857 | 2023 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Singh 2010 Microfistulas from the left anterior interventricular coronary artery percolating the ventricular septum. PMID:2010246 | 1991 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
| Wali 2012 Analysis of isotype-specific antifilarial antibody levels in a Haitian pediatric population. PMID:2012259 | 1991 | this review only | Pain-free IANB success (no intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults with permanent mandibular posterior teeth diagnosed with symptomatic irreversible pulpitis undergoing nonsurgical endodontic treatment under IANB | Adults with mandibular posterior teeth with SIP (n=737 participants, 11 RCTs) |
| Intervention | Oral NSAID premedication given before IANB | Oral NSAIDs: diclofenac 50 mg (n=4 trials), ketorolac 10 mg (n=5), ibuprofen 400-600 mg (n=5), lornoxicam, piroxicam, naproxen, aceclofenac, flurbiprofen (n=1 each) |
| Comparison | Oral placebo administered in the same timing window | Oral placebo (n=11 trials) |
| Outcomes | Pain-free IANB success (no patient-reported intraoperative pain at any recorded step after initial IANB and no supplemental anesthesia); adverse events when available | Pain-free IANB success (n=11 trials); adverse events reported in 3 trials, not pooled |
| Study designs | RCTs | RCTs (n=11) |
| Timing | Intraoperative, after initial IANB | Intraoperative: access only (n=5 trials) or access plus instrumentation/pulp extirpation (n=6 trials) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Yes | Partial Yes | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Moderate | Moderate | yes |