A Cochrane review [Abstract] 1 included 18 studies of oral diclofenac in postoperative pain with a total of 3714 subjects. Diclofenac potassium 50 mg, in seven studies, produced an NNT for at least 50% of maximum pain relief compared with placebo of 2.1 (95% CI 1.9 to 2.5). There was a graded improvement in efficacy as doses rose from 25 mg to 100 mg, both for participants achieving at least 50% maximum pain relief, and for remedication within 6 to 8 hours. Fast-acting formulations (dispersible products, solutions, and softgel formulations) had a similar efficacy for a 50 mg dose, with an NNT of 2.4 (2.0 to 3.0). Diclofenac sodium in a small number of studies produced a lesser effect, with an NNT of 6.6 (4.1 to 17) for the 50 mg dose.Adverse event rates were low in these single dose studies, with no difference between diclofenac and placebo.
A Cochrane review [Abstract]10included 3 studies of oral dexketoprofen 25mg in postoperative pain with a total of 1853 subjects. The proportion of participants achieving at least 50% pain relief over 6 hours with dexketoprofen 25 mg plus tramadol 75 mg was 66%, compared to 32% with placebo (RR 2.1, 95% CI 1.7 to 2.4; 3 trials, n=748), giving an NNT of 3.0 (95% CI 2.5 to 3.7). The response rate with dexketoprofen 25 mg alone was 53% (RR 1.3, 95% CI 1.1 to 1.4; n=744) and with tramadol alone was 45% (RR 1.5, 95% CI 1.3 to 1.7; n=741). Adverse event rates were low.
A Cochrane review [Abstract] 2 included 72 studies of oral ibuprofen in postoperative pain with a total of 9 186 subjects. Most of the information came from 200 mg and 400 mg ibuprofen doses. For at least 50% pain relief over 4 to 6 hours compared with placebo the NNT for ibuprofen 200 mg (n=2 690) was 2.7 (95% CI 2.5 to 3.0), for ibuprofen 400 mg (n=6 475) it was 2.5 (95% CI 2.4 to 2.6) and for ibuprofen 600 mg (n=203) 2.7 (2.0 to 4.2).
A Cochrane review [Abstract] 3 included 15 studies on single oral dose of naproxen or naproxen sodium for acute postoperative pain in adults, with a total of 1 509 subjects. Meta-analysis of 9 studies (784 patients) that compared 500/550 mg naproxen or naproxen sodium with placebo gave a RR for at least 50% pain relief over 4 to 6 hours of 3.4 (95% CI 2.6 to 4.4) and an NNT of 2.7 (95% CI 2.3 to 3.3). Three trials (334 patients) assessed naproxen 400 mg and naproxen sodium 440 mg, giving a RR of 4.8 (95% CI 2.8 to 8.4) and an NNT of 2.7 (2.2 to 3.5). Two small studies (n=202) indicated that naproxen 200 mg and naproxen sodium 220 mg may provide effective postoperative pain relief; the relative benefit of treatment compared with placebo was 2.9 (1.6 to 5.1), giving an NNT of 3.4 (2.4 to 5.8).
A Cochrane review [Abstract] 4 included only one study on single oral dose of aceclofenac for acute postoperative pain in adults, with a total of 217 subjects. Aceclofenac 150 mg could not be distinguished from placebo, though ibuprofen 400 mg was distinguished from placebo.
A Cochrane review [Abstract] 5 included two studies on single oral dose of dexibuprofen for acute postoperative pain in adults. In both studies dexibuprofen gave high levels of response, with 51/96 (53%) participants experiencing at least 50% pain relief with dexibuprofen 200 mg and 35/50 (70%) with dexibuprofen 400 mg, compared with 75/147 (51%) with racemic ibuprofen 400 mg, and 12/62 (13%) with placebo. The median time to additional analgesic use was greater than four hours for all active therapies, but about two hours for placebo.Adverse events were generally of mild or moderate intensity and consistent with events normally associated with anaesthesia and surgery. There were no serious adverse events or deaths.
A Cochrane review [Abstract] 6 included 9 studies of oral etodolac in postoperative pain with a total of 1 459 subjects. For at least 50% pain relief over 4 to 6 hours compared with placebo the NNT for etodolac 100 mg (498 participants) was 4.8 (3.5 to 7.8) and for etodolac 200 mg (670 participants) it was 3.3 (2.7 to 4.2).
A Cochrane review [Abstract] 7 included 9 studies of oral flurbiprofen in postoperative pain with a total of 1 061 subjects. The NNT for at least 50% pain relief over 4 to 6 hours for flurbiprofen 50 mg compared with placebo (692 participants) was 2.7 (2.3 to 3.3) and for 100 mg (416 participants) it was 2.5 (2.0 to 3.1).
A Cochrane review [Abstract] 8 included 18 studies; ketoprofen was studies in 14 studies (n=2510) and dexketoprofen in 7 studies (n=1275). Ketoprofen at doses between 12.5 mg and 100 mg produced NNTs for at least 50% pain relief over 4 to 6 hours of 2.4 to 3.3. For dental studies only there was a trend to more efficacy at higher doses, with NNT decreasing from 2.4 at 12.5 mg to 1.6 at 100 mg. Dexketoprofen at doses of 10/12.5 mg and 20/25 mg produced NNTs for at least 50% pain relief over 4 to 6 hours of 3.2 and 3.6, with no obvious dose response.
A Cochrane review[Abstract] 9 included 3 studies of oral lornoxicam with a total of 628 subjects. Lornoxicam doses varied from 2 mg to 32 mg. All the participants had pain following third molar extraction, and study duration was 8 to 24 hours. The NNT for at least 50% pain relief over 6 hours after a single dose of lornoxicam 8 mg was 2.9 (2.3 to 4.0). There were insufficient data to analyse other doses or use of rescue medication.
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