Efficacy of NSAIDs and corticosteroids as premedication for post-endodontic pain management: A systematic review and meta-analysis

J Clin Exp Dent. 2025 Dec 30;18(1):e105-e115. doi: 10.4317/jced.63455. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Post-endodontic pain remains a common clinical challenge. This systematic review and meta-analysis evaluated the preemptive efficacy of NSAIDs and corticosteroids as premedication for managing postoperative pain in patients with symptomatic irreversible pulpitis undergoing non-surgical root canal treatment. Objectives: To compare the preemptive efficacy of NSAIDs and corticosteroids as single-dose premedication in reducing postoperative pain and rescue medication use after endodontic treatment.

MATERIAL AND METHODS: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Cochrane Library, and Embase up to April 2024. Eligibility criteria included randomized controlled trials comparing single-dose NSAIDs or corticosteroids with placebo. Primary outcomes were postoperative pain intensity measured by validated scales (VAS, NRS, HP-VAS) and need for rescue analgesics. Risk of bias was assessed with RoB2, and certainty of evidence with GRADE. Meta-analysis used random-effects models, with standardized mean differences (SMD) and 95% confidence intervals (CI). Protocol registered in PROSPERO (CRD42024499723).

RESULTS: Seven RCTs (n=820) published between 2009 and 2023 were included. Both corticosteroids (SMD = -1.28; 95 % confidence interval (CI): -1.96 to -0.61) and NSAIDs (SMD = -0.61; 95% CI: -1.11 to -0.10) significantly reduced postoperative pain versus placebo. NSAIDs provided rapid analgesia at 6 h, while corticosteroids achieved sustained analgesia from 12-48 h. Rescue analgesic use decreased substantially in both active groups compared with placebo (NSAIDs 4.6%, corticosteroids 5.5%, placebo 34.4%). High heterogeneity (I² = 90%) was partly explained by drug class, dose, and administration route. Sensitivity analysis excluding imputed data confirmed robustness of results.

CONCLUSIONS: Both NSAIDs and corticosteroids are effective preemptive agents for managing post-endodontic pain in symptomatic irreversible pulpitis. NSAIDs should be preferred for rapid early relief, while corticosteroids provide extended analgesia. Findings highlight their opioid-sparing potential and support their inclusion in evidence-based endodontic pain management protocols. Further multicenter RCTs are warranted to refine patient-tailored regimens.

PMID:41716365 | PMC:PMC12916047 | DOI:10.4317/jced.63455