The efficacy of non-narcotic analgesics on post-operative endodontic pain: A systematic review and meta-analysis: The efficacy of non-steroidal anti-inflammatory drugs and/or paracetamol on post-operative endodontic pain

Abstract

The objective of this review was to evaluate the efficacy of non-narcotic analgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post-operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta-regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta-analysis was performed using a random-effect inverse variance method. Meta-regression analysis was conducted to examine the associations between effect sizes and study-level covariates (P < 0·05). The results showed that administration of non-narcotic analgesic was more effective than placebo in the management of post-operative pain, resulting in a lower pain scores with a standardised mean difference of −0·50 (95% CI= −0·70, −0·30), −0·76 (95%CI= −0·95, −0·56), −1·15 (95% CI= −1·52, −0·78), −0·65 (95% CI= −1·05, −0·26) for immediately after the procedure, 6−, 12− and 24 h post−operative follow-ups (test for statistical heterogeneity: P = 0·000, P = 0·000, P = 0·000 and P = 0·001), respectively. Our meta-regression analysis provided the evidence for association between some study covariates with treatment effect, each at different follow-ups. We concluded that the clinicians can manage post-operative endodontic pain by administration of NSAIDs and/or paracetamol. However, analgesic regimens should be considered as important determinants when prescribing a pharmacological adjuvant.