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Single dose oral diclofenac for acute postoperative pain in adults.

Abstract

BACKGROUND

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), available as a potassium salt (immediate-release) or sodium salt (delayed-release). This review updates an earlier review published in The Cochrane Database of Systematic Reviews (Issue 2, 2004) on 'Single dose oral diclofenac for postoperative pain'.

OBJECTIVES

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

SEARCH STRATEGY

Cochrane CENTRAL, MEDLINE, EMBASE, Biological Abstracts, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008.

SELECTION CRITERIA

Randomised, double-blind, placebo-controlled clinical trials of single dose, oral diclofenac (sodium or potassium) for acute postoperative pain in adults.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for inclusion and quality, and extracted data. The area under the pain relief versus time curve was used to derive the proportion of participants with at least 50% pain relief over 4 to 6 hours, using validated equations. Relative benefit (risk) and number needed to treat to benefit (NNT) were calculated. Information on adverse events, time to remedication, and participants needing additional analgesia was also collected.

MAIN RESULTS

Fifteen studies (eight additional studies) with 1512 participants more than doubled the information available at each dose. Overall 50% to 60% of participants experienced at least 50% pain relief over 4 to 6 hours at any dose with diclofenac, compared to 10 to 20% with placebo, giving NNTs of about 2.5 for doses of 25 mg to 100 mg (similar to earlier review); no dose response was demonstrated. At 50 mg and 100 mg, NNTs for diclofenac potassium (2.1 (1.8 to 2.4) and 1.9 (1.7 to 2.2)) were significantly lower (better) than for diclofenac sodium (6.7 (4.2 to 17) and 4.5 (3.2 to 7.7)). The median time to use of rescue medication was 2 hours for placebo, 4.3 hours for diclofenac 50 mg and 4.9 hours for diclofenac 100 mg. Adverse events were reported at a similar rate to placebo, with no serious events.

AUTHORS' CONCLUSIONS

Oral diclofenac is an effective single-dose treatment for moderate to severe postoperative pain. Significantly more participants experienced at least 50% pain relief over 4 to 6 hours with diclofenac potassium than with diclofenac sodium. There was no significant difference between diclofenac and placebo in the incidence of adverse events.

Authors+Show Affiliations

Pain Research, University of Oxford, Nuffield Department of Anaesthetics, 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

19370609

Citation

Derry, Philip, et al. "Single Dose Oral Diclofenac for Acute Postoperative Pain in Adults." The Cochrane Database of Systematic Reviews, 2009, p. CD004768.
Derry P, Derry S, Moore RA, et al. Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009.
Derry, P., Derry, S., Moore, R. A., & McQuay, H. J. (2009). Single dose oral diclofenac for acute postoperative pain in adults. The Cochrane Database of Systematic Reviews, (2), CD004768. https://doi.org/10.1002/14651858.CD004768.pub2
Derry P, et al. Single Dose Oral Diclofenac for Acute Postoperative Pain in Adults. Cochrane Database Syst Rev. 2009 Apr 15;(2)CD004768. PubMed PMID: 19370609.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single dose oral diclofenac for acute postoperative pain in adults. AU - Derry,Philip, AU - Derry,Sheena, AU - Moore,R Andrew, AU - McQuay,Henry J, Y1 - 2009/04/15/ PY - 2009/4/17/entrez PY - 2009/4/17/pubmed PY - 2009/6/24/medline SP - CD004768 EP - CD004768 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), available as a potassium salt (immediate-release) or sodium salt (delayed-release). This review updates an earlier review published in The Cochrane Database of Systematic Reviews (Issue 2, 2004) on 'Single dose oral diclofenac for postoperative pain'. OBJECTIVES: To assess single dose oral diclofenac for the treatment of acute postoperative pain. SEARCH STRATEGY: Cochrane CENTRAL, MEDLINE, EMBASE, Biological Abstracts, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. SELECTION CRITERIA: Randomised, double-blind, placebo-controlled clinical trials of single dose, oral diclofenac (sodium or potassium) for acute postoperative pain in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and quality, and extracted data. The area under the pain relief versus time curve was used to derive the proportion of participants with at least 50% pain relief over 4 to 6 hours, using validated equations. Relative benefit (risk) and number needed to treat to benefit (NNT) were calculated. Information on adverse events, time to remedication, and participants needing additional analgesia was also collected. MAIN RESULTS: Fifteen studies (eight additional studies) with 1512 participants more than doubled the information available at each dose. Overall 50% to 60% of participants experienced at least 50% pain relief over 4 to 6 hours at any dose with diclofenac, compared to 10 to 20% with placebo, giving NNTs of about 2.5 for doses of 25 mg to 100 mg (similar to earlier review); no dose response was demonstrated. At 50 mg and 100 mg, NNTs for diclofenac potassium (2.1 (1.8 to 2.4) and 1.9 (1.7 to 2.2)) were significantly lower (better) than for diclofenac sodium (6.7 (4.2 to 17) and 4.5 (3.2 to 7.7)). The median time to use of rescue medication was 2 hours for placebo, 4.3 hours for diclofenac 50 mg and 4.9 hours for diclofenac 100 mg. Adverse events were reported at a similar rate to placebo, with no serious events. AUTHORS' CONCLUSIONS: Oral diclofenac is an effective single-dose treatment for moderate to severe postoperative pain. Significantly more participants experienced at least 50% pain relief over 4 to 6 hours with diclofenac potassium than with diclofenac sodium. There was no significant difference between diclofenac and placebo in the incidence of adverse events. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19370609/Single_dose_oral_diclofenac_for_acute_postoperative_pain_in_adults_ L2 - https://doi.org/10.1002/14651858.CD004768.pub2 DB - PRIME DP - Unbound Medicine ER -