基于证据的临床实践指南,用于治疗急性牙痛
Victoria G Green1, Deborah E Polk2, Michael A Turturro3
1University of Pittsburgh, Department of Dental Hygiene, School of Dental Medicine, Pittsburgh, PA, USA.
推使用非阿片类止痛药,如NSAID和乙氨基来治疗牙痛. 这些提供比阿片类药物更好的缓解和安全,用于牙痛和拔牙后疼痛.
科学领域:
- 牙科药理学 牙科药理学
- 疼痛管理 疼痛管理
- 临床实践指南 临床实践指南
背景情况:
- 紧急诊所 (ED) 经常治疗牙科疾病,据估计,在美国,诊断时间为15秒.
- 由于牙疼痛和拔牙而引起的急性牙疼痛是一个重大的临床挑战.
- 2024年临床实践指南涉及在没有立即牙科护理的环境中药理管理.
研究的目的:
- 总结在紧急和紧急护理环境中管理急性牙痛的建议.
- 为指导使用止痛药,局部麻醉药和皮质类固醇治疗牙痛.
- 为ED,医院和缺乏最终牙科治疗的诊所提供基于证据的战略.
主要方法:
- 一个指导方针小组审查了关于阿片类和非阿片类止痛药,局部麻醉药和皮质类固醇的证据.
- 根据GRADE (建议评估,开发和评价的分级) 方法,评估了证据的确定性.
- 根据GRADE证据决策框架,制定了18项建议和6项良好实践陈述.
主要成果:
- 非阿片类药物表现出比阿片类药物治疗牙痛的药物具有有利的净平衡.
- 与阿片类药物相比,非类固醇抗炎药物 (NSAID),单独或与乙氨基一起,在没有禁忌的情况下提供更好的止痛和安全性.
- 证据支持非阿片类止痛药作为主要治疗选择的有效性和安全性.
结论:
- 用或不用乙氨基的NSAIDs被推作为急性牙抽取后疼痛和暂时牙痛管理的第一线治疗.
- 类阿片类止痛药应保留在第一线治疗不足或NSAIDs禁用的情况下.
- 该指南强调在紧急情况下转向非阿片类药物药物治疗,用于常见的牙痛情景.
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