What question did this study set out to answer?

To compare and rank single-dose oral analgesics for effective pain management after third molar extraction.

April 7, 2026Open Access

Management of pain with oral analgesia after extraction of lower third molars: a network meta-analysis of randomized controlled trials

Key Points

To compare and rank single-dose oral analgesics for effective pain management after third molar extraction.
Conducted a network meta-analysis of randomized controlled trials (RCTs).
Analyzed total pain relief outcomes over a period of 6 hours.
Included data from nineteen RCTs involving 3615 third molar surgeries.
Standardized data for comparability and graded the certainty of evidence.
All active drug classes provided better pain relief than placebo.
The combination of an opioid and NSAID was the most effective treatment strategy.
NSAIDs alone ranked second in effectiveness.
Pairwise comparisons showed opioids combined with non-opioid analgesics had superior efficacy.
Observed significant inconsistency and variable treatment effects across studies.

Abstract

The aim of this network meta-analysis was to compare and rank single-dose oral analgesics for managing moderate-to-severe pain after third molar surgery, to address limitations of prior reviews.Major databases were searched for relevant randomized controlled trials (RCTs), and guidelines for reporting systematic reviews were followed.The primary outcome was total pain relief over 6 h, with data standardized for comparability.A frequentist network meta-analysis was performed to estimate mean differences and rank treatment strategies.The certainty of the evidence was formally graded.Nineteen randomized controlled trials involving 3615 third molar surgeries were included in the network meta-analysis.All active drug classes outperformed placebo.The combination of an opioid with a non-steroidal anti-inflammatory drug (NSAID) ranked as the most effective strategy, followed by NSAIDs alone.Additionally, the combination of opioids with non-opioid analgesics showed superior efficacy compared to either as monotherapy in pairwise comparisons, although this was not fully reflected in the overall treatment ranking, where it did not outperform non-opioid analgesics.Significant inconsistency was found across the evidence network, and certainty for most comparisons was very low to moderate.Consequently, given the high heterogeneity across studies, treatment effects may vary, warranting careful consideration in clinical practice.

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