通讯作者: 王晓东, landuoduo99@163.com

DOI：10.12201/bmr.202611.00022

Different Preemptive Analgesia Regimens for the Management of Irreversible Pulpitis: A Randomized, Double-Blind, Placebo-Controlled Trial

• 摘要：目的：比较右旋酮洛芬氨丁三醇(D-KPT)及地塞米松(DM)多种超前镇痛给药方案对不可逆性牙髓炎(IP)患者诊疗效果的影响。方法：采用随机、双盲、安慰剂对照的析因设计。将108例IP患者随机分为四组(n= 27)。术前1 h，A组口服安慰剂片 + 患牙颊侧根尖区黏膜下注射生理盐水1ml；B组口服D-KPT 12.5 mg + 注射生理盐水1ml；C组口服安慰剂片 + 注射DM 4mg/ml；D组口服D-KPT 12.5 mg + 注射DM 4mg/ml。随后患者均接受含1:200000肾上腺素的2%利多卡因行下牙槽神经阻滞(IANB)。记录IANB情况，采用HP-VAS、Houpt、MDAS量表分别评价术中疼痛及行为、焦虑水平，对比各组给药方案的临床效果。结果：A、B、C、D组IANB成功率分别为22.2%、40.7%、70.4%、92.6%。在IANB成功率方面，C组显著高于A组(P＜0.0083)，D组显著高于A组及B组(P＜0.0083)；而A组与B组、B组与C组、C组与D组间成功率差异均无统计学意义(P＞0.0083)。HP-VAS评分组间比较显示，D组评分显著优于A、B、C组(P＜0.05)，C组评分显著优于A组(P＜0.05)，而A组与B组、B组与C组间差异无统计学意义(P＞0.05)。在术后MDAS及术中Houpt评分组间比较显示，C、D组均显著优于A、B组(P＜0.05)，而A组与B组、C组与D组间差异均无统计学意义(P＞0.05)。四组患者术中HP-VAS及术后MDAS评分均较术前显著降低(P＜0.05)。结论：术前应用DM或D-KPT联合DM均可提高IANB成功率、减轻术中疼痛、改善术中行为配合并缓解牙科焦虑；但联合用药在减轻术中疼痛方面更具优势。

  关键词： 右旋酮洛芬氨丁三醇; 地塞米松; 下牙槽神经阻滞; 术中疼痛; 不可逆性牙髓炎

   

  Abstract: Objective: This study aimed to investigate the impacts of different preemptive analgesia protocols with dexketoprofen trometamol (D-KPT) and dexamethasone (DM) on treatment outcomes of patients with irreversible pulpitis.Methods: This study adopted a randomized, double-blind, placebo-controlled factorial design. 108 patients with irreversible pulpitis were included and randomly divided into 4 groups( n = 27). All patients received both an oral tablet and a submucosal injection at the buccal periapical area of the affected tooth. Group A received placebo tablets plus 1 ml normal saline injection; Group B received oral 12.5 mg D-KPT and 1 ml normal saline injection; Group C received placebo tablets plus 4 mg/ml DM injection; Group D received oral 12.5 mg D-KPT combined with 4 mg/ml DM injection. All patients received inferior alveolar nerve block (IANB) with 2% lidocaine containing 1:200000 epinephrine. The conditions of IANB were recorded. Heft-Parker visual analogue scale (HP-VAS), Modified Dental Anxiety Scale (MDAS) and Houpt scale were used to assess pain, anxiety and intraoperative behavior, respectively, to compare the efficacy of different medication regimens.Results: The success rates of IANB in Group A, B, C and D were 22.2%, 40.7%, 70.4% and 92.6%, respectively. Groups C and D achieved significantly higher IANB success rates than Group A (P＜0.0083), Group D also showed superior success rates compared with Group B (P＜0.0083). No significant differences were found between Groups A and B, B and C, as well as C and D (P>0.0083). The HP-VAS scores in Group D were significantly lower than those in Groups A, B, and C (P<0.05), and those in Group C were significantly lower than in Group A (P<0.05). No significant differences were found between Groups A and B, or between Groups B and C (P>0.05). Groups C and D had significantly better postoperative MDAS and intraoperative Houpt scores than Groups A and B (P<0.05), while no significant differences were found between A and B, or between C and D (P>0.05).  Intraoperative HP-VAS and postoperative MDAS scores were significantly decreased compared with baseline values in all four groups (P<0.05).Conclusion: Preoperative DM alone or combined with D-KPT both increase the IANB success rate, reduce intraoperative pain, improve intraoperative behavioral cooperation, and alleviate dental anxiety, with the combination regimen offering a significantly greater reduction in intraoperative pain.

  Key words: dexketoprofen tromethamine; dexamethasone; Inferior alveolar nerve block, intraoperative pain, irreversible pulpitis; ; 

  提交时间：2026-11-15

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• 序号	提交日期	编号	操作
  1	2026-09-30	10.12201/bmr.202611.00022V1	下载

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