• Fábio Wildson Gurgel Costa, Diego Felipe Silveira Esses, Paulo Goberlânio de Barros Silva, Francisco Samuel Rodrigues Carvalho, Carlos Diego Lopes Sá, Assis Filipe Medeiros Albuquerque, Tácio Pinheiro Bezerra, Thyciana Rodrigues Ribeiro, Cristiane Sá Roriz Fonteles, and Eduardo Costa Studart Soares.
• Adjunct Professor, Division of Oral Radiology, School of Dentistry, Federal University of Ceará, Brazil.
• Anesth Prog. 2015 Jan 1;62(2):57-63.

AbstractThe purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.

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