Combining Paracetamol (Acetaminophen) with Nonsteroidal Antiinflammatory Drugs

Ong, Cliff K. S.; Seymour, R. A.; Lirk, Phillip; Merry, Alan

doi:10.1213/ane.0b013e3181cf9281

Cited by 548 publications

(295 citation statements)

References 50 publications

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“…47 The efficacy of an acetaminophen-NSAID combination also applies in multimodal analgesic regimens that do not utilize opioids. For instance, the combination of single-dose acetaminophen (0.5-1 g) and ibuprofen (200-400 mg) after dental surgery provides better acute postoperative analgesia than either drug alone, with reduced analgesic needs and reduced risk of adverse events.…”

Section: Acetaminophen (Paracetamol)mentioning

confidence: 99%

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Tan

Law

Gan

2014

Can J Anesth/J Can Anesth

277

206

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Section: Acetaminophen (Paracetamol)mentioning

confidence: 99%

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Tan

Law

Gan

2014

Can J Anesth/J Can Anesth

277

206

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“…[1][2][3] The rationale underlying the practice of combining drugs for pain management is mainly based on the consideration that combining drugs that act at different receptors and on different pain mechanisms might enhance pain relief. Paracetamol acts mainly on the brain and spinal cord; nevertheless, the exact mechanism of action has not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Simplified UVB Model to Assess the Pharmacodynamics of Analgesics in Healthy Human Volunteers

Lorenzini

Besson²,

Daali³

et al. 2012

Chimia

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A pharmacokinetic/pharmacodynamic, randomized, crossover, placebo-controlled study was conducted in healthy human volunteers with the primary objective of exploring the existence of a positive interaction between paracetamol 1 g and ketorolac 20 mg intravenously on experimental pain models. Further, the simplified UVB model was validated as a screening tool for analgesics or a combination of analgesics in clinical drug development. It was observed that the UVB irradiation induced primary hyperalgesia, evidenced by significant decreases of the heat pain threshold from (mean ± SD) 46.9 ± 1.1°C to 40.1 ± 1.7°C (p<0.001) and of the mechanical pain threshold (62% decrease). A small intra-and inter-individual variability was observed as well as consistent intra-day stability for the heat pain threshold. The UVB irradiation also resulted in the development of an area of secondary hyperalgesia of 21.3 ± 11.3 cm 2 . The mechanical pain threshold and area of secondary hyperalgesia showed small intra-individual variability and consistent intra-day stability. However, a greater variability was observed between subjects, which suggests that a crossover design would allow limiting the number of subjects.

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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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Combining Paracetamol (Acetaminophen) with Nonsteroidal Antiinflammatory Drugs

Abstract: Current evidence suggests that a combination of paracetamol and an NSAID may offer superior analgesia compared with either drug alone.

Cited by 548 publications

References 50 publications

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Validation of the Simplified UVB Model to Assess the Pharmacodynamics of Analgesics in Healthy Human Volunteers

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

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