AIM This randomized, double blinded, clinical trial evaluated the effect of oral premedication of piroxicam, prednisolone, dexamethasone or placebo on postoperative pain after single-visit root canal treatment in teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis. METHODOLOGY The trial is reported according to the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines. The protocol was registered at the clinical trial registry (India) (CTRI/2019/06/019818). In total, 160 patients, assigned to four groups, received orally either 20 mg piroxicam, 20 mg prednisolone, 4 mg dexamethasone or a placebo 60 minutes before root canal treatment. Patients recorded their postoperative pain intensity at 6h, 12h, 24h, 48h and, 72h using a 10-cm Visual Analogue Scale. Intergroup comparison was performed using Kruskal-Wallis tests with post Hoc analysis using Dunns Test. Incidence of pain was analyzed using Chi Square tests. A p value < 0.05 was considered to be statistically significant. Binary logistic regression was used to determine the odds of postoperative pain, with incidence of pain as the dependent variable and intervention groups, gender, age and type of tooth as independent variables. RESULTS In total, 156 patients were analyzed in the trial, since four patients dropped out during follow-up. All drugs were associated with a significantly lower incidence of postoperative pain compared to the placebo at 6h (p=0.009), 12h (p=0.003) and 24h (p=0.008). Mean intensity of pain was significantly more intense at 6h, 12h and 24h with the use of placebo in comparison to the other three intervention groups (p < 0.05). Intensity of pain was not significantly different between the premedications used (p > 0.05). One patient, in the piroxicam group reported gastritis, whereas no adverse effects were recorded in other groups. CONCLUSION Preoperative oral administration of a single dose of 4 mg dexamethasone, 20 mg piroxicam or 20 mg prednisolone reduced the incidence and severity of postoperative pain following single-visit root canal treatment compared to a placebo in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis up to 24h. The odds of postoperative pain at 24h for patients premedicated with 4 mg dexamethasone or 20 mg piroxicam or 20 mg prednisolone was 5.3 times, 3.4 times and 2.5 times less compared to the placebo respectively.

中文翻译：

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相比于抗炎药，术前口服类固醇对单次访问根管治疗后术后疼痛的效果-一项双盲，随机临床试验。

目的该随机，双盲，临床试验评估了吡罗昔康，泼尼松龙，地塞米松或安慰剂的口服前药对有症状的不可逆性牙髓炎和有症状的根尖性牙周炎的牙齿进行单次根管治疗后对术后疼痛的影响。方法学该试验根据《牙髓治疗随机对照试验的首选报告项目》（PRIRATE）2020指南进行报告。该方案已在临床试验注册中心（印度）注册（CTRI / 2019/06/019818）。总共有160名患者（分为四组）在根管治疗前60分钟口服了20 mg吡罗昔康，20 mg强的松龙，4 mg地塞米松或安慰剂。患者使用10厘米视觉模拟量表记录其术后6h，12h，24h，48h和72h的疼痛强度。使用Kruskal-Wallis检验进行组间比较，并使用Dunns检验进行事后分析。使用卡方检验分析疼痛发生率。p值<0.05被认为具有统计学意义。二元逻辑回归用于确定术后疼痛的几率，以疼痛发生率为因变量，干预组，性别，年龄和牙齿类型为自变量。结果总共有156例患者接受了分析，因为有4例患者在随访期间退出了研究。与安慰剂相比，在6h（p = 0.009），12h（p = 0.003）和24h（p = 0.008）时，所有药物的术后疼痛发生率均显着降低。在6小时时，平均疼痛强度明显增强，与其他三个干预组相比，使用安慰剂治疗12h和24h（p <0.05）。所用药物之间的疼痛强度无明显差异（p> 0.05）。吡罗昔康组的一名患者报告了胃炎，而其他组未观察到不良反应。结论与安慰剂相比，对于有症状的不可逆性牙髓炎和有症状的根尖性牙周炎的患者，术前口服4 mg地塞米松，20 mg吡罗昔康或20 mg强的松龙可降低单次根管治疗后的术后疼痛发生率和严重程度到24小时 服用4 mg地塞米松或20 mg吡罗昔康或20 mg泼尼松龙的患者在24h发生术后疼痛的几率是5.3倍，3.4倍和2。