The analgesic efficacy of diclofenac dispersible and ibuprofen in postoperative pain after dental extraction

Ahlström, Ulf; Bakshi, Rajesh; Nilsson, Peter; Wåhlander, L.

doi:10.1007/bf02440865

Cited by 17 publications

(21 citation statements)

References 4 publications

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“…These authors demonstrated an additive effect of paracetamol over the whole study period of 8 h. Their study also showed less use of rescue medication in the combination group compared with the patients treated with diclofenac alone, something also found in a study by Matthews et al (19). It would seem reasonable to assume that the additive effect of paracetamol in our study would be the same as in these two studies as rofecoxib and ibuprofen have been shown to have the same analgesic effect following third molar surgery (9,10,12) and the effects of ibuprofen and diclofenac are similar (30)(31)(32). It cannot be ruled out that there is a difference in additive effect of paracetamol when combining it with rofecoxib compared with diclofenac.…”

Section: Discussionsupporting

confidence: 84%

“…(19). It would seem reasonable to assume that the additive effect of paracetamol in our study would be the same as in these two studies as rofecoxib and ibuprofen have been shown to have the same analgesic effect following third molar surgery (9, 10, 12) and the effects of ibuprofen and diclofenac are similar (30–32). It cannot be ruled out that there is a difference in additive effect of paracetamol when combining it with rofecoxib compared with diclofenac.…”

Section: Discussionmentioning

confidence: 57%

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Combining paracetamol with a selective cyclooxygenase‐2 inhibitor for acute pain relief after third molar surgery: a randomized, double‐blind, placebo‐controlled study

Haglund

Bültzingslöwen

2006

European J Oral Sciences

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Severe pain after third molar surgery is often encountered and more effective treatment regimes are warranted. The objective of this study was to evaluate if the combination of paracetamol and rofecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, improves analgesic effects following third molar surgery compared with rofecoxib alone. Paracetamol alone was also evaluated. Altogether 120 patients with moderate to severe pain after third molar surgery were given a single postoperative dose of one of the following treatments: rofecoxib + paracetamol; rofecoxib alone; paracetamol alone; or placebo. Patients assessed level of pain and pain relief every 30 min for 8 h after surgery, and made a global evaluation of the medication 4 and 8 h after surgery. Paracetamol and rofecoxib combined improved the analgesic effect compared with rofecoxib alone for the first 1.5 h. Rofecoxib alone and the combination of paracetamol and rofecoxib had a significantly better analgesic effect than paracetamol alone from 3 h onwards. The early onset of pain relief for the combination of paracetamol and rofecoxib, compared with rofecoxib alone, could be of great importance when treating acute pain after third molar surgery. After data collection for this study, rofecoxib was withdrawn from the market as a result of reported fatal cardiovascular events. Whether this is relevant for short-term use is unknown, but it has to be considered before rofecoxib may be used for pain relief following third molar surgery.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 57%

Combining paracetamol with a selective cyclooxygenase‐2 inhibitor for acute pain relief after third molar surgery: a randomized, double‐blind, placebo‐controlled study

Haglund

Bültzingslöwen

2006

European J Oral Sciences

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“…The proportion of participants with at least 50% pain relief was 54% (1000/1842) for ibuprofen 400 mg, and 12% (152/1244) for placebo; the RB was 4.4 (3.8 to 5.2), and the NNT was 2.4 (2.2 to 2.6). Fourteen studies had fewer than 40 participants in both treatment arms (Ahlstrom 1993; Ehrich 1999; Forbes 1984;Forbes 1990; Forbes 1991b; Forbes 1992; Hersch 1993b; Laska 1986; McQuay 1996; Nørholt 1998; Schwartz 2007; Seymour 1991 (study 1); Seymour 1991 (study 2); Seymour 1996) (Analysis 4.5.2). The proportion of participants with at least 50% pain relief was 60% (280/463) for ibuprofen 400 mg, and 14% (56/393) for placebo; the RB was 4.1 (3.2 to 5.2), and the NNT was 2.2 (1.9 to 2.5).…”

Section: Resultsmentioning

confidence: 99%

Single dose oral ibuprofen for acute postoperative pain in adults

Derry

Derry²,

Moore³

et al. 2009

Cochrane Database of Systematic Reviews

116

113

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Background This review updates a 1999 Cochrane review showing that ibuprofen at various doses was effective in postoperative pain in single dose studies designed to demonstrate analgesic efficacy. New studies have since been published. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory (NSAID) analgesics both by prescription and as an over-the-counter medicine. Ibuprofen is used for acute and chronic painful conditions. Objectives To assess analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered ibuprofen (any formulation) in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Seventy-two studies compared ibuprofen and placebo (9186 participants). Studies were predominantly of high reporting quality, and the bulk of the information concerned ibuprofen 200 mg and 400 mg. For at least 50% pain relief compared with placebo the NNT for ibuprofen 200 mg (2690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6475 participants) it was 2.5 (2.4 to 2.6). The proportion with at least 50% pain relief was 46% with 200 mg and 54% with 400 mg. Remedication within 6 hours was less frequent with higher doses, with 48% remedicating with 200 mg and 42% with 400 mg. The median time to remedication was 4.7 hours with 200 mg and 5.4 hours with 400 mg. Sensitivity analysis indicated that pain model and ibuprofen formulation may both affect the result, with dental impaction models and soluble ibuprofen salts producing better efficacy estimates. Adverse events were uncommon, and not different from placebo. Authors’ conclusions The very substantial amount of high quality evidence demonstrates that ibuprofen is an effective analgesic in treating postoperative pain. NNTs for 200 mg and 400 mg ibuprofen did not change significantly from the previous review even when a substantial amount of new information was added. New information is provided on remedication.

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“…The proportion of participants with at least 50% pain relief was 54% (1000/1842) for ibuprofen 400 mg, and 12% (152/1244) for placebo; the RB was 4.4 (3.8 to 5.2), and the NNT was 2.4 (2.2 to 2.6). Fourteen studies had fewer than 40 participants in both treatment arms (Ahlstrom 1993;Ehrich 1999;Forbes 1984;Forbes 1990;Forbes 1991b;Forbes 1992;Hersch 1993b;Laska 1986;Nørholt 1998;Schwartz 2007; (study 1); Seymour 1991 (study 2); Seymour 1996) (Analysis 4.5.2). The proportion of participants with at least 50% pain relief was 60% (280/463) for ibuprofen 400 mg, and 14% (56/393) for placebo; the RB was 4.1 (3.2 to 5.2), and the NNT was 2.2 (1.9 to 2.5).…”

Section: Ibuprofen 400 Mg: (Analysis 45)mentioning

confidence: 99%