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Single dose oral paracetamol (acetaminophen) for postoperative pain.

Abstract

BACKGROUND

Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of mild and moderate pain arising from headache, musculoskeletal conditions and dysmenorrhoea. A prior Cochrane systematic review concluded that paracetamol is also effective for postoperative pain, but additional trials have since been published. This review sought to evaluate the efficacy and safety of paracetamol using current data, and to compare the findings with other analgesics evaluated in the same way.

OBJECTIVES

To assess the efficacy of single dose oral paracetamol for the treatment of acute postoperative pain.

SEARCH STRATEGY

We searched the Cochrane Library (Issue 3, 2002), the trials register of the Cochrane Pain, Palliative and Supportive Care group (November 2002); MEDLINE (1966 to May 1996); PubMed (1996 to August 2001); EMBASE (1980 to 1996); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles in order to update an existing version of the review.

SELECTION CRITERIA

Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. The area under the 'pain relief versus time' curve was used to derive the proportion of patients with paracetamol or placebo experiencing least 50% pain relief over four to six hours using validated equations. The number-needed-to-treat (NNT) was calculated using 95% confidence intervals. Information on adverse effects was also collected.

MAIN RESULTS

Forty-seven reports that enrolled 4186 patients (2561 patients were treated with a single oral dose of paracetamol and 1625 with placebo) met the inclusion criteria and were included in the analyses. The NNTs for at least 50% pain relief over four to six hours following a single dose of paracetamol were as follows: 325 mg NNT 3.8 (2.2 to 13.3); 500 mg NNT 3.5 (2.7 to 4.8); 600/650 mg NNT 4.6 (3.9 to 5.5); 975/1000 mg NNT 3.8 (3.4 to 4.4); and 1500 mg NNT 3.7 (2.3 to 9.5). Sub-group analysis showed no significant differences between smaller and larger trials, or lower and higher quality trials. Drug-related study withdrawals were rarely reported. Studies reported a variable incidence of adverse effects that were generally mild and transient. There were no statistically significant differences in the frequency of reported adverse effects between paracetamol 975/1000 mg and placebo.

REVIEWER'S CONCLUSIONS

Single doses of paracetamol are effective analgesics for acute postoperative pain and give rise to few adverse effects.

Authors+Show Affiliations

Pain Research Unit, University of Oxford, Churchill Hospital, Old Road, Oxford, UK, OX3 7LJ.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

14974073

Citation

Barden, J, et al. "Single Dose Oral Paracetamol (acetaminophen) for Postoperative Pain." The Cochrane Database of Systematic Reviews, 2004, p. CD004602.
Barden J, Edwards J, Moore A, et al. Single dose oral paracetamol (acetaminophen) for postoperative pain. Cochrane Database Syst Rev. 2004.
Barden, J., Edwards, J., Moore, A., & McQuay, H. (2004). Single dose oral paracetamol (acetaminophen) for postoperative pain. The Cochrane Database of Systematic Reviews, (1), CD004602.
Barden J, et al. Single Dose Oral Paracetamol (acetaminophen) for Postoperative Pain. Cochrane Database Syst Rev. 2004;(1)CD004602. PubMed PMID: 14974073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single dose oral paracetamol (acetaminophen) for postoperative pain. AU - Barden,J, AU - Edwards,J, AU - Moore,A, AU - McQuay,H, PY - 2004/2/20/pubmed PY - 2004/6/30/medline PY - 2004/2/20/entrez SP - CD004602 EP - CD004602 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of mild and moderate pain arising from headache, musculoskeletal conditions and dysmenorrhoea. A prior Cochrane systematic review concluded that paracetamol is also effective for postoperative pain, but additional trials have since been published. This review sought to evaluate the efficacy and safety of paracetamol using current data, and to compare the findings with other analgesics evaluated in the same way. OBJECTIVES: To assess the efficacy of single dose oral paracetamol for the treatment of acute postoperative pain. SEARCH STRATEGY: We searched the Cochrane Library (Issue 3, 2002), the trials register of the Cochrane Pain, Palliative and Supportive Care group (November 2002); MEDLINE (1966 to May 1996); PubMed (1996 to August 2001); EMBASE (1980 to 1996); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles in order to update an existing version of the review. SELECTION CRITERIA: Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. The area under the 'pain relief versus time' curve was used to derive the proportion of patients with paracetamol or placebo experiencing least 50% pain relief over four to six hours using validated equations. The number-needed-to-treat (NNT) was calculated using 95% confidence intervals. Information on adverse effects was also collected. MAIN RESULTS: Forty-seven reports that enrolled 4186 patients (2561 patients were treated with a single oral dose of paracetamol and 1625 with placebo) met the inclusion criteria and were included in the analyses. The NNTs for at least 50% pain relief over four to six hours following a single dose of paracetamol were as follows: 325 mg NNT 3.8 (2.2 to 13.3); 500 mg NNT 3.5 (2.7 to 4.8); 600/650 mg NNT 4.6 (3.9 to 5.5); 975/1000 mg NNT 3.8 (3.4 to 4.4); and 1500 mg NNT 3.7 (2.3 to 9.5). Sub-group analysis showed no significant differences between smaller and larger trials, or lower and higher quality trials. Drug-related study withdrawals were rarely reported. Studies reported a variable incidence of adverse effects that were generally mild and transient. There were no statistically significant differences in the frequency of reported adverse effects between paracetamol 975/1000 mg and placebo. REVIEWER'S CONCLUSIONS: Single doses of paracetamol are effective analgesics for acute postoperative pain and give rise to few adverse effects. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/14974073/Single_dose_oral_paracetamol__acetaminophen__for_postoperative_pain_ L2 - https://doi.org/10.1002/14651858.CD004602 DB - PRIME DP - Unbound Medicine ER -