Preoperative Etoricoxib Reduces Postoperative Pain and Improves Functional Recovery in Third Molar Extraction: A Systematic Review and Meta-Analysis.

BACKGROUND

Though postoperative acute pain following third molar extraction impairs patient satisfaction and increases health care costs, evidence regarding the efficacy of the highly selective cyclooxygenase-2 inhibitor etoricoxib for preemptive analgesia in this setting remains unclear.

PURPOSE: The purpose of this study was to measure the association of etoricoxib preemptive analgesia on pain and functional recovery after third molar surgery.

DATA SOURCES: The databases CENTRAL, MEDLINE, Embase, Scopus, Web of Science, CNKI, and WANFANG were searched from inception to March 2025 (English and Chinese) using the keywords "Etoricoxib" and "Third Molar."

STUDY SELECTION: Randomized controlled trials (RCTs) comparing etoricoxib with placebo for third molar extraction were included; non-RCTs and reviews were excluded. Three researchers independently screened the literature.

DATA EXTRACTION AND SYNTHESIS: This study is a systematic review and meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for data extraction. The Cochrane tool assessed risk of bias. Review Manager 5.4.1 analyzed data, applying fixed- or random-effects models according to heterogeneity.

MAIN OUTCOMES: The predictor variable was preoperative intervention type (etoricoxib vs placebo). The outcome variables were postoperative pain and functional recovery: pain was assessed by visual analog scale (VAS) scores (1 to 144 hours postoperatively), postoperative analgesic consumption, time to first analgesic use, and proportion of subjects using rescue analgesics; functional recovery was measured by degree of facial edema and maximum mouth opening. Covariates included surgical difficulty, etoricoxib dosage, and timing of preoperative administration.

RESULTS

Six RCTs involving 456 subjects (aged 18 to 44 years) were included. VAS scores were lower in the etoricoxib group (1 to 6 hours: mean difference [MD] = -2.33; 8 to 24 hours: MD = -1.31, both P < .00001). Analgesic consumption at 24 hours was lower (MD = -0.86, P < .00001). Time to first rescue analgesic use ranged from 12.1 to 27.6 hours versus 2.1 to 4.0 hours in placebo. The proportion of subjects using rescue analgesics was 29 to 78% versus 75 to 100% in placebo. Maximum mouth opening was greater (MD = 6.00, P < .00001). A 120-mg dose reduced VAS scores in complex surgeries (MD = -2.23; 95% CI: -2.85 to -1.61); 30-minute preoperative administration showed low heterogeneity (I2 = 0%).

CONCLUSIONS

Preoperative administration of etoricoxib was associated with reduced acute postoperative pain and improved functional recovery. A preoperative dose of 120 mg of etoricoxib was correlated with more favorable analgesic and functional outcomes for complex third molar extractions compared with lower doses.