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Eficácia de analgésicos, anti-inflamatórios e opioides no tratamento da dor dentária: uma revisão sistemática
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Resumo(s)
A gestão da dor dentária aguda pós-operatória enfrenta o desafio de equilibrar a eficácia analgésica com a minimização de riscos, num contexto global de crise de opioides. Objetivo: Esta revisão sistemática teve como objetivo avaliar a eficácia comparativa e segurança de analgésicos não opioides (AINEs e Paracetamol), isolados ou em combinação, versus opioides, em adultos submetidos a cirurgia oral. Metodologia: Seguiu-se o protocolo PRISMA 2020. Foi realizada uma pesquisa abrangente nas bases de dados PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science e Scopus (até dezembro de 2024). Foram incluídos Ensaios Clínicos Randomizados (ECR) duplo-cegos que reportassem dados quantitativos de intensidade ou alívio da dor. A qualidade metodológica foi avaliada pela escala de Jadad. Resultados: A pesquisa identificou 134 registos iniciais, resultando na inclusão final de 10 ECR de alta qualidade metodológica na análise quantitativa. A análise dos resultados demonstrou que o Ibuprofeno é consistentemente superior ao placebo, com diferenças de médias ajustadas a atingir os 48.05 pontos (Förderreuther et al., 2020). A Combinação de Dose Fixa (FDC) de Ibuprofeno e Paracetamol revelou-se superior à monoterapia de Ibuprofeno, apresentando ganhos adicionais de alívio da dor entre 2.7 e 4.7 pontos (Kellstein & Leyva, 2020). Comparativamente, os protocolos com opioides (ex: Codeína/Paracetamol) mostraram-se inferiores a AINEs potentes (como Rofecoxib), com uma diferença de eficácia de 22.1 pontos a desfavor dos opioides (Chang et al., 2001). Conclusão: A evidência atual suporta uma estratégia "Opioid-Sparing". A combinação de Ibuprofeno e Paracetamol deve ser considerada a primeira linha terapêutica para dor dentária moderada a severa, oferecendo um rácio eficácia/segurança superior aos opioides. O uso de opioides deve ser reservado estritamente para casos refratários.
Managing acute postoperative dental pain faces the challenge of balancing analgesic efficacy with minimizing risks, particularly within the global context of the opioid crisis. Objective: This systematic review aimed to evaluate the comparative efficacy and safety of non-opioid analgesics (NSAIDs and Paracetamol), alone or in combination, versus opioids, in adults undergoing oral surgery. Methodology: The PRISMA 2020 protocol was followed. A comprehensive search was conducted in the PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus databases (up to December 2024). Double-blind Randomized Controlled Trials (RCTs) that reported quantitative data on pain intensity or pain relief were included. Methodological quality was assessed using the Jadad scale. Results: The search identified 134 initial records, resulting in the final inclusion of 10 RCTs of high methodological quality for quantitative analysis. The analysis of results demonstrated that Ibuprofen is consistently superior to placebo, with adjusted mean differences reaching 48.05 points (Förderreuther et al., 2020). The Fixed-Dose Combination (FDC) of Ibuprofen and Paracetamol proved superior to Ibuprofen monotherapy, showing additional pain relief gains between 2.7 and 4.7 points (Kellstein & Leyva, 2020). Comparatively, opioid protocols (e.g., Codeine/Paracetamol) were shown to be inferior to potent NSAIDs (such as Rofecoxib), with an efficacy difference of 22.1 points favoring the NSAIDs (Chang et al., 2001). Conclusion: Current evidence supports an "Opioid-Sparing" strategy. The combination of Ibuprofen and Paracetamol should be considered the first-line therapeutic option for moderate-tosevere dental pain, offering a superior efficacy/safety ratio compared to opioids. The use of opioids should be strictly reserved for refractory cases.
Managing acute postoperative dental pain faces the challenge of balancing analgesic efficacy with minimizing risks, particularly within the global context of the opioid crisis. Objective: This systematic review aimed to evaluate the comparative efficacy and safety of non-opioid analgesics (NSAIDs and Paracetamol), alone or in combination, versus opioids, in adults undergoing oral surgery. Methodology: The PRISMA 2020 protocol was followed. A comprehensive search was conducted in the PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus databases (up to December 2024). Double-blind Randomized Controlled Trials (RCTs) that reported quantitative data on pain intensity or pain relief were included. Methodological quality was assessed using the Jadad scale. Results: The search identified 134 initial records, resulting in the final inclusion of 10 RCTs of high methodological quality for quantitative analysis. The analysis of results demonstrated that Ibuprofen is consistently superior to placebo, with adjusted mean differences reaching 48.05 points (Förderreuther et al., 2020). The Fixed-Dose Combination (FDC) of Ibuprofen and Paracetamol proved superior to Ibuprofen monotherapy, showing additional pain relief gains between 2.7 and 4.7 points (Kellstein & Leyva, 2020). Comparatively, opioid protocols (e.g., Codeine/Paracetamol) were shown to be inferior to potent NSAIDs (such as Rofecoxib), with an efficacy difference of 22.1 points favoring the NSAIDs (Chang et al., 2001). Conclusion: Current evidence supports an "Opioid-Sparing" strategy. The combination of Ibuprofen and Paracetamol should be considered the first-line therapeutic option for moderate-tosevere dental pain, offering a superior efficacy/safety ratio compared to opioids. The use of opioids should be strictly reserved for refractory cases.
Descrição
Palavras-chave
Dor dentária AINEs Opioides Paracetamol Eficácia Segurança Dental pain NSAIDs Opioids Efficacy Safety