Effectiveness of combined extraoral vibration and cooling on pain perception due to inferior alveolar nerve block administration in children: a systematic review and meta-analysis.

Abstract

The inferior alveolar nerve block (IANB) is one of the most painful procedures, especially in children. Effective pain management during IANB is a critical prerequisite for the successful treatment of pediatric patients. This systematic review aimed to evaluate the combined effectiveness of extraoral vibration and cooling (EVC) in reducing pain perception during IANB in children. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the compilation of this systematic review. PROSPERO registration was performed using registration number CRD42024558538. PubMed, ScienceDirect, Cochrane, Google Scholar, and LILACS were searched for relevant studies published from the inception of the databases until January 1, 2025. Studies that compared the use of EVC with conventional methods for IANB in children were selected. The primary and secondary outcomes were subjective and objective measures of pain, respectively. The initial search of the five electronic databases yielded 483 records. After excluding 113 duplicates and screening 309 irrelevant titles and abstracts, 61 studies were included. Of these, six were selected for full-text analysis, and three studies met the inclusion criteria for the final systematic review. Meta-analysis was feasible for two of these studies because of their comparable methodologies and outcome measures. All included studies involved pediatric patients aged 5-12 years undergoing IANB. The intervention group underwent IANB using a combination of EVC, whereas the control group underwent conventional IANB without adjuncts. Pain and anxiety were assessed using both subjective (Wong-Baker Faces Pain Scale) and objective (Face, Legs, Activity, Cry, Consolability) scoring systems. The results indicated a statistically significant reduction in pain scores in the EVC group than in the control group, suggesting that EVC may be an effective adjunct for improving pain perception during IANB in children. Pain perception during IANB was significantly lower in the combined EVC group than in the control group. However, meta-analysis reports indicated that there was no significant difference in pain perception between the intervention and control groups.