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

Abstract

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.

Frequency of post obturation pain by using ibuprofen and ibuprofen/dexamethasone infiltration in single visit root canal treatment cases

“…9,15 However, the single or short term use at high dose was proved to be safe procedures in the absence of contraindication to its use. 2,16 This seems to support the present results where there was no evidence of infection subsequent to intraoral local injection of dexamethasone. Only one case exhibited pus oozing after root canal instrumentation.…”

“…In the field of endodontics, the pain is relieved by chemo-mechanical preparation for the effective cleaning of causative organisms and obturation of the root canals that prevents and discourages the re-entry of infected flora into the root canal system. 1,2 In cases of irreversible pulpitis or pulp necrosis, the treatment of choice is root canal treatment. Irreversible pulpitis is characterized by the presence of severe pain that can be throbbing or stabbing.…”

Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief

“…In a case report, a geriatric patient with decompensated heart failure received oral diclofenac 25 mg/day resulted in nephrotoxicity (25). A study assessed pain control using oral ibuprofen and acetaminophen in patients after wisdom teeth extraction did not report incidents of AKI after 48-hour use (26).…”

Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children

“…11 We employed a Bonferroni correction to allow for the independent assessment of the two pain measures. Forty-eight children per group would give 80% power to show a difference of 9 mm in the AUCt with a comparison-wise type 1 error rate of 0.025 (one-sided) and an overall rate of 0.05.…”

“…Nevertheless, it is the view of our research group that alleviating pain is a fundamental human right 21 and that there are serious ethical concerns about allowing pain to develop in order to show analgesic effect. 11,22,23 For this Children at the Indian sites were discharged to an inpatient ward for 48 hr. Children at the New Zealand sites were discharged home following time in the recovery room A global pain rating (rated by participant as nil (1), mild (2), moderate (3), or severe (4)) was collected on the first postoperative day.…”