Single dose oral ibuprofen for acute postoperative pain in adults Stable (no update expected for reasons given in 'What's new')

Abstract

Abstract 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.

Author(s)

Christopher J Derry, Sheena Derry, R Andrew Moore, Henry J McQuay

Abstract

Plain language summary

A single dose of ibuprofen administered orally to treat acute postoperative pain in adults

Ibuprofen at 200 mg and 400 mg produces a high level of pain relief in about half of those with moderate or severe acute postoperative pain. This is a good result compared with most other analgesics tested in a very well researched model of pain used for demonstrating that drugs can actually produce pain relief. There were no more adverse events than with placebo.

Author(s)

Christopher J Derry, Sheena Derry, R Andrew Moore, Henry J McQuay

Reviewer's Conclusions

Authors' conclusions

Implications for practice

This updated review does not change the overall primary estimate of efficacy, the NNT for at least 50% pain relief over 4 to 6 hours compared with placebo, but does demonstrate differences in efficacy with different formulations, and provides additional estimates of efficacy in terms of use of rescue medication.

A single dose of ibuprofen 400 mg is an effective analgesic, providing at least 50% pain relief to over half of the treated patients with acute, moderate to severe, postoperative pain. The NNT of 2.5 for at least 50% pain relief compares favourably with other analgesics commonly used for postoperative pain. In single dose, it is associated with a low rate of adverse events, similar to that with placebo. Lower doses provide slightly lower levels of analgesia. The 200 mg dose has a shorter duration of action. The more soluble salts of ibuprofen appear to offer better analgesia for a longer time. The amount of information available for 200 mg and 400 mg dwarfs almost all other analgesics except paracetamol and aspirin.

Implications for research

The most important implication for research is to clarify the apparent difference in efficacy between the standard and more soluble preparations of ibuprofen. A preparation with better efficacy than standard ibuprofen may present an opportunity to provide equivalent analgesia at a reduced dose, and potentially improve safety in longer term use. It should always be the goal to use the lowest dose of a drug that provides the desired clinical effect, and lower doses are likely to be associated with fewer adverse events in clinical practice.

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