A comparison of paracetamol, ibuprofen or their combination for pain relief following extractions in children under general anaesthesia: a randomized controlled trial

Gazal, Giath; Mackie, I C

doi:10.1111/j.1365-263x.2006.00806.x

Cited by 56 publications

(67 citation statements)

References 23 publications

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“…68911–13 Ibuprofen has the advantage of a well-established safety record (particularly at doses below 1.5 g per day in adults), 14 and in many countries (including the UK), it is available without prescription. Typically, acetaminophen is given in a dose regimen of 1 g 6 hourly whereas ibuprofen is given in a dose of 400 mg 8 hourly.…”

mentioning

confidence: 99%

Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial

Merry

Gibbs

Edwards³

et al. 2010

British Journal of Anaesthesia

102

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BackgroundAcetaminophen is often used with a non-steriodal anti-inflammatory drug for acute pain. Hitherto, these drugs have had to be given separately, typically at different time intervals. Maxigesic® tablets combine acetaminophen and ibuprofen in clinically appropriate doses to simplify administration and dosage regimen. We compared this combination with each of the constituent drugs for the relief of pain after extraction of third molar teeth.MethodsAdults (more than 16 yr) having one or more wisdom teeth removed under general or local anaesthesia were instructed to take two tablets before operation, then two tablets every 6 h for up to 48 h of: (i) a combination of acetaminophen 500 mg and ibuprofen 150 mg per tablet (Maxigesic®); (ii) acetaminophen 500 mg per tablet alone; or (iii) ibuprofen 150 mg per tablet alone. The primary outcome measure was the area under the curve (AUC) of the 100 mm visual analogue scale pain measurements taken for up to 48 h after surgery, divided by time, at rest and on activity. Pharmacokinetic data were collected in a subset of patients.ResultsThe mean (sem) time-corrected AUC on rest and activity, respectively, were: combination group 22.3 (3.2) and 28.4 (3.4); acetaminophen group 33.0 (3.1) and 40.4 (3.3); and ibuprofen group 34.8 (3.2) and 40.2 (3.4); P<0.01 for each of the four comparisons of combination vs constituent drug. There was no pharmacokinetic interaction between acetaminophen and ibuprofen administered together.ConclusionsMaxigesic® tablets provide superior pain relief after oral surgery to acetaminophen or ibuprofen alone.

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mentioning

confidence: 99%

Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial

Merry

Gibbs

Edwards³

et al. 2010

British Journal of Anaesthesia

102

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“…Furthermore, none of the published studies were performed in the ED; they were all conducted in the post-operative period [41]. Compared with paracetamol alone, the combination of paracetamol and ibuprofen was better for dental extraction [33] and tonsillectomy [42]. No study has compared NSAIDs alone versus a combination of paracetamol and an NSAID.…”

Section: Oral Paracetamol and Nsaid Combinedmentioning

confidence: 96%

“…Eleven other studies found no significant differences [30]. Ibuprofen was superior to paracetamol to increase comfort in febrile children [31], after musculoskeletal trauma [32], following dental extraction [33][34][35], and for the treatment of headaches [36]. Of interest to children in the ED, ibuprofen was not superior to paracetamol in the treatment of sore throat [37,38] or pain associated with illness [39].…”

Section: Oral Paracetamol or Non-steroidalmentioning

confidence: 99%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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“…To date, there is limited but promising evidence to support the practice of combining acetaminophen and ibuprofen for pain treatment in children. [20][21][22][23][24] As noted by others, there remains a need for large-scale studies on both the efficacy and safety of this combination for the treatment of pain. 20 When asked to choose their preferred oral analgesic, respondents showed a strong preference for ibuprofen over acetaminophen.…”

Section: Discussionmentioning

confidence: 99%

Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians

MacLellan

Ali

Curtis

et al. 2016

CJEM

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Objectives: Gingivostomatitis is a common, painful pediatric presentation, and yet, few studies are available to guide management. We aimed to describe pediatric emergency physicians' current practice patterns, with respect to analgesic use in children with acute gingivostomatitis, in order to inform future studies. Methods: A national survey was conducted at all 15 national academic pediatric centres.Electronic surveys were distributed to pediatric emergency physicians using a modified Dillman protocol; non-respondents received paper surveys via post. Data were collected regarding demographic characteristics, clinical behaviour, factors that may influence practice, and future directions. Results: Response rate was 74% (150/202). Most physicians (72%) preferred the combination of acetaminophen and ibuprofen to either agent alone (ibuprofen 19%, acetaminophen 7%). The preferred second-line analgesics were oral morphine (48%, 72/150) and compounded topical formulas (42%, 64/150). The most commonly cited compounded agent was Benadryl plus Maalox (23%, 35/150). Clinical experience with a medication had the greatest influence on practice pattern, with 52% (78/149) strongly agreeing. The most commonly cited barrier to adequate analgesia was difficulty in the administration of topical or oral medication to children. Conclusions: As with many other painful conditions, the combination of acetaminophen and ibuprofen was preferred, followed by either agent alone. Oral morphine and topical compounded agents were also frequently prescribed. Regardless of patient age, physicians preferred oral morphine as a secondline agent to treat pain from severe gingivostomatitis. Future research will focus on determining which analgesic and route (oral or topical) is the most effective and best-tolerated choice. . Le facteur qui influait le plus sur la pratique était l'expérience clinique d'un médicament; en effet, 52% (78/149) des participants se sont dits « tout à fait d'accord » sur l'énoncé. Enfin, le plus grand obstacle à une analgésie suffisante était la difficulté d'administration des médicaments topiques ou oraux aux enfants. Conclusions: Comme dans bien d'autres affections douloureuses, l'association d'acétaminophène et d'ibuprofène était la formule préférée, suivie de l'utilisation seule de l'un ou l'autre de ces médicaments. Étaient souvent prescrits aussi la morphine par voie orale et les composés topiques. Indépen-damment de l'âge, les médecins préféraient la morphine par voie orale comme médicament de deuxième intention pour traiter la douleur causée par une gingivostomatite importante. Enfin, les futurs travaux de recherche devraient porter sur l'analgésique le plus efficace et la meilleure voie d'administration (orale ou topique) ainsi que sur la formule la mieux tolérée.

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A comparison of paracetamol, ibuprofen or their combination for pain relief following extractions in children under general anaesthesia: a randomized controlled trial

Abstract: This study provides evidence to support the oral administration of ibuprofen alone or in combination with paracetamol for postoperative analgesia in children who are having teeth extracted under GA.

Cited by 56 publications

References 23 publications

Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial

Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial

Managing Pediatric Pain in the Emergency Department

Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians

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