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Single dose oral paracetamol (acetaminophen) for postoperative pain in adults.

Abstract

BACKGROUND

This is an updated version of the original Cochrane review published in Issue 1, 2004 - this original review had been split from a previous title on 'Single dose paracetamol (acetaminophen) with and without codeine for postoperative pain'. The last version of this review concluded that paracetamol is an effective analgesic 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, MEDLINE, EMBASE, the Oxford Pain Relief Database and reference lists of articles to update an existing version of the review in July 2008.

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

Fifty-one studies, with 5762 participants, were included: 3277 participants were treated with a single oral dose of paracetamol and 2425 with placebo. About half of participants treated with paracetamol at standard doses achieved at least 50% pain relief over four to six hours, compared with about 20% treated with placebo. NNTs for at least 50% pain relief over four to six hours following a single dose of paracetamol were as follows: 500 mg NNT 3.5 (2.7 to 4.8); 600 to 650 mg NNT 4.6 (3.9 to 5.5); 975 to 1000 mg NNT 3.6 (3.4 to 4.0). There was no dose response. Sensitivity analysis showed no significant effect of trial size or quality on this outcome.About half of participants needed additional analgesia over four to six hours, compared with about 70% with placebo. Five people would need to be treated with 1000 mg paracetamol, the most commonly used dose, to prevent one needing rescue medication over four to six hours, who would have needed it with placebo. Adverse event reporting was inconsistent and often incomplete. Reported adverse events were mainly mild and transient, and occurred at similar rates with 1000 mg paracetamol and placebo. No serious adverse events were reported. Withdrawals due to adverse events were uncommon and occurred in both paracetamol and placebo treatment arms.

AUTHORS' CONCLUSIONS

A single dose of paracetamol provides effective analgesia for about half of patients with acute postoperative pain, for a period of about four hours, and is associated with few, mainly mild, adverse events.

Authors+Show Affiliations

Pain Research and Nuffield Department of Anaesthetics, University of Oxford, West Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, UK, OX3 9DU.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

18843665

Citation

Toms, Laurence, et al. "Single Dose Oral Paracetamol (acetaminophen) for Postoperative Pain in Adults." The Cochrane Database of Systematic Reviews, 2008, p. CD004602.
Toms L, McQuay HJ, Derry S, et al. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev. 2008.
Toms, L., McQuay, H. J., Derry, S., & Moore, R. A. (2008). Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. The Cochrane Database of Systematic Reviews, (4), CD004602. https://doi.org/10.1002/14651858.CD004602.pub2
Toms L, et al. Single Dose Oral Paracetamol (acetaminophen) for Postoperative Pain in Adults. Cochrane Database Syst Rev. 2008 Oct 8;(4)CD004602. PubMed PMID: 18843665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. AU - Toms,Laurence, AU - McQuay,Henry J, AU - Derry,Sheena, AU - Moore,R Andrew, Y1 - 2008/10/08/ PY - 2008/10/10/pubmed PY - 2009/1/16/medline PY - 2008/10/10/entrez SP - CD004602 EP - CD004602 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - BACKGROUND: This is an updated version of the original Cochrane review published in Issue 1, 2004 - this original review had been split from a previous title on 'Single dose paracetamol (acetaminophen) with and without codeine for postoperative pain'. The last version of this review concluded that paracetamol is an effective analgesic 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, MEDLINE, EMBASE, the Oxford Pain Relief Database and reference lists of articles to update an existing version of the review in July 2008. SELECTION CRITERIA: Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Area under the "pain relief versus time" curve was used to derive the proportion of participants with paracetamol or placebo experiencing at least 50% pain relief over four to six hours, using validated equations. Number-needed-to-treat-to-benefit (NNT) was calculated, with 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use, were sought as measures of duration of analgesia. Information on adverse events and withdrawals was also collected. MAIN RESULTS: Fifty-one studies, with 5762 participants, were included: 3277 participants were treated with a single oral dose of paracetamol and 2425 with placebo. About half of participants treated with paracetamol at standard doses achieved at least 50% pain relief over four to six hours, compared with about 20% treated with placebo. NNTs for at least 50% pain relief over four to six hours following a single dose of paracetamol were as follows: 500 mg NNT 3.5 (2.7 to 4.8); 600 to 650 mg NNT 4.6 (3.9 to 5.5); 975 to 1000 mg NNT 3.6 (3.4 to 4.0). There was no dose response. Sensitivity analysis showed no significant effect of trial size or quality on this outcome.About half of participants needed additional analgesia over four to six hours, compared with about 70% with placebo. Five people would need to be treated with 1000 mg paracetamol, the most commonly used dose, to prevent one needing rescue medication over four to six hours, who would have needed it with placebo. Adverse event reporting was inconsistent and often incomplete. Reported adverse events were mainly mild and transient, and occurred at similar rates with 1000 mg paracetamol and placebo. No serious adverse events were reported. Withdrawals due to adverse events were uncommon and occurred in both paracetamol and placebo treatment arms. AUTHORS' CONCLUSIONS: A single dose of paracetamol provides effective analgesia for about half of patients with acute postoperative pain, for a period of about four hours, and is associated with few, mainly mild, adverse events. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/18843665/Single_dose_oral_paracetamol__acetaminophen__for_postoperative_pain_in_adults_ L2 - https://doi.org/10.1002/14651858.CD004602.pub2 DB - PRIME DP - Unbound Medicine ER -