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

Abstract

Abstract Background

Nabumetone is a non‐steroidal anti‐inflammatory drug (NSAID) used mainly in treating pain associated with arthritis. The usual oral dose for osteoarthritis is 1000 mg daily, and higher doses are not advised in older patients. There are no known systematic reviews of its analgesic efficacy in acute postoperative pain. This review sought to evaluate the efficacy and safety of oral nabumetone in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish whether drugs have analgesic properties.

Objectives

To assess the efficacy of single dose oral nabumetone in acute postoperative pain, and any associated adverse events.

Search methods

We searched The Cochrane Library (Issue 2, 2009), MEDLINE (May 2009); EMBASE via Ovid (May 2009); and the Oxford Pain Relief Database.

Selection criteria

Randomised, double‐blind, placebo‐controlled clinical trials of oral nabumetone for relief of acute postoperative pain in adults.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. The area under the "pain relief versus time" curve was used to derive the proportion of participants with nabumetone and placebo experiencing at least 50% pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected.

Main results

No studies were identified by the searches that examined oral nabumetone in participants with established postoperative pain.

Authors' conclusions

In the absence of evidence of efficacy, at present, for oral nabumetone in acute postoperative pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes, there is no urgent research agenda.

Author(s)

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

Abstract

Plain language summary

Single dose oral nabumetone for postoperative pain in adults

Pain is commonly experienced after surgical procedures. Post operative pain is a good model to test whether or not drugs are effective painkillers in participants with moderate or severe pain. In this case we could find no studies that tested oral nabumetone against placebo. It is possible that the studies were conducted, but not reported, because they were used only to register nabumetone with licensing authorities throughout the world. However, this leaves an important gap in our knowledge, and it means that we cannot be confident about using oral nabumetone for acute painful conditions.

Author(s)

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

Reviewer's Conclusions

Authors' conclusions

Implications for practice

In the absence of evidence of efficacy at present for oral nabumetone in acute postoperative pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully.

Implications for research

Given the large number of available drugs of this and similar classes to treat postoperative pain, there is no urgent research agenda.

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