Tags

Type your tag names separated by a space and hit enter

Effect size comparison of ketorolac nasal spray and commonly prescribed oral combination opioids for pain relief after third molar extraction surgery.
Postgrad Med. 2016 Jan; 128(1):12-7.PM

Abstract

OBJECTIVE

Opioids are frequently used for treatment of moderate to severe short-term pain, but concerns exist about this treatment approach. Ketorolac tromethamine nasal spray, a nonsteroidal anti-inflammatory, is indicated for the short-term management of moderate to moderately severe pain requiring analgesia at the opioid level. However, there are no direct comparison studies between ketorolac nasal spray and opioids. The objective of this study was to use an effect size analysis to compare the effectiveness of ketorolac nasal spray with oral combination opioid formulations in treating moderate to severe short-term pain.

METHODS

An effect size analysis of three randomized, double-blind, placebo-controlled studies of third molar extraction surgery compared pain relief with ketorolac nasal spray and commonly prescribed combination opioids including hydrocodone/acetaminophen (APAP), oxycodone/APAP, oxycodone/ibuprofen and tramadol HCl/APAP. Effect size comparisons were made using total pain relief scores (TOTPAR6 or TOTPAR8; the weighted sum of pain relief scores through 6 or 8 h). Pain relief was measured using a five-point categorical rating scale (0 = none; 4 = complete). The effect size equivalent correlation, r, was determined using an online effect size calculator. The treatment effect size r compared with placebo was classified using established criteria (small = 0.20-0.49, moderate = 0.50-0.79 and large = ≥ 0.80).

RESULTS

TOTPAR6 data indicated a moderate effect size for ketorolac nasal spray 31.5 mg (0.51) and oxycodone/ibuprofen 5/400 mg (0.64) and a small effect size for hydrocodone/APAP 7.5/500 mg (0.24) and oxycodone/APAP 5/325 mg (0.32). TOTPAR8 data indicated small effect sizes for ketorolac nasal spray (0.48), hydrocodone/APAP 10/650 mg (0.43), tramadol HCl/APAP 75/650 mg (0.35) and tramadol HCl/APAP 37.5/325 mg (0.17).

CONCLUSION

The treatment effect sizes of ketorolac nasal spray were similar to or higher than the opioid comparators after third molar surgery, a well-accepted pain model. These results support ketorolac nasal spray as an effective treatment for moderate to moderately severe short-term pain.

Authors+Show Affiliations

a Egalet Corporation , Wayne , PA , USA.a Egalet Corporation , Wayne , PA , USA.

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26616001

Citation

Niebler, Gwendolyn, and Jeffrey Dayno. "Effect Size Comparison of Ketorolac Nasal Spray and Commonly Prescribed Oral Combination Opioids for Pain Relief After Third Molar Extraction Surgery." Postgraduate Medicine, vol. 128, no. 1, 2016, pp. 12-7.
Niebler G, Dayno J. Effect size comparison of ketorolac nasal spray and commonly prescribed oral combination opioids for pain relief after third molar extraction surgery. Postgrad Med. 2016;128(1):12-7.
Niebler, G., & Dayno, J. (2016). Effect size comparison of ketorolac nasal spray and commonly prescribed oral combination opioids for pain relief after third molar extraction surgery. Postgraduate Medicine, 128(1), 12-7. https://doi.org/10.1080/00325481.2016.1126185
Niebler G, Dayno J. Effect Size Comparison of Ketorolac Nasal Spray and Commonly Prescribed Oral Combination Opioids for Pain Relief After Third Molar Extraction Surgery. Postgrad Med. 2016;128(1):12-7. PubMed PMID: 26616001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect size comparison of ketorolac nasal spray and commonly prescribed oral combination opioids for pain relief after third molar extraction surgery. AU - Niebler,Gwendolyn, AU - Dayno,Jeffrey, Y1 - 2015/12/17/ PY - 2015/12/1/entrez PY - 2015/12/1/pubmed PY - 2016/5/21/medline KW - Combination opioids KW - effect size KW - efficacy KW - ketorolac nasal spray KW - nonsteroidal anti-inflammatory drug (NSAID) KW - pain SP - 12 EP - 7 JF - Postgraduate medicine JO - Postgrad Med VL - 128 IS - 1 N2 - OBJECTIVE: Opioids are frequently used for treatment of moderate to severe short-term pain, but concerns exist about this treatment approach. Ketorolac tromethamine nasal spray, a nonsteroidal anti-inflammatory, is indicated for the short-term management of moderate to moderately severe pain requiring analgesia at the opioid level. However, there are no direct comparison studies between ketorolac nasal spray and opioids. The objective of this study was to use an effect size analysis to compare the effectiveness of ketorolac nasal spray with oral combination opioid formulations in treating moderate to severe short-term pain. METHODS: An effect size analysis of three randomized, double-blind, placebo-controlled studies of third molar extraction surgery compared pain relief with ketorolac nasal spray and commonly prescribed combination opioids including hydrocodone/acetaminophen (APAP), oxycodone/APAP, oxycodone/ibuprofen and tramadol HCl/APAP. Effect size comparisons were made using total pain relief scores (TOTPAR6 or TOTPAR8; the weighted sum of pain relief scores through 6 or 8 h). Pain relief was measured using a five-point categorical rating scale (0 = none; 4 = complete). The effect size equivalent correlation, r, was determined using an online effect size calculator. The treatment effect size r compared with placebo was classified using established criteria (small = 0.20-0.49, moderate = 0.50-0.79 and large = ≥ 0.80). RESULTS: TOTPAR6 data indicated a moderate effect size for ketorolac nasal spray 31.5 mg (0.51) and oxycodone/ibuprofen 5/400 mg (0.64) and a small effect size for hydrocodone/APAP 7.5/500 mg (0.24) and oxycodone/APAP 5/325 mg (0.32). TOTPAR8 data indicated small effect sizes for ketorolac nasal spray (0.48), hydrocodone/APAP 10/650 mg (0.43), tramadol HCl/APAP 75/650 mg (0.35) and tramadol HCl/APAP 37.5/325 mg (0.17). CONCLUSION: The treatment effect sizes of ketorolac nasal spray were similar to or higher than the opioid comparators after third molar surgery, a well-accepted pain model. These results support ketorolac nasal spray as an effective treatment for moderate to moderately severe short-term pain. SN - 1941-9260 UR - https://www.unboundmedicine.com/medline/citation/26616001/Effect_size_comparison_of_ketorolac_nasal_spray_and_commonly_prescribed_oral_combination_opioids_for_pain_relief_after_third_molar_extraction_surgery_ L2 - https://www.tandfonline.com/doi/full/10.1080/00325481.2016.1126185 DB - PRIME DP - Unbound Medicine ER -