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Evidence summaries

Ibuprofen Alone or in Combination with Codeine or Caffeine in Post-Surgical Pain

Ibuprofen is an effective analgesic for post-surgical pain. Codeine enhances the analgesic effect slightly, but also increases the risk of inducing drowsiness. Level of evidence: "A"

A systematic review 1 including 40 RCTs containing 75 placebo comparisons (58 of which were ibuprofen vs placebo comparisons) and 10 head-to-head comparisons was abstracted in DARE.

Ibuprofen was effective compared to placebo (NNT for moderate to excellent pain relief 2.44, 95% CI 2.19 to 2.77). Pooling across all types of pain, the difference in percentage total pain-relief score was 8.48 (95% CI 0.95 to 16.01) for ibuprofen 400 mg plus codeine 60 mg compared to ibuprofen 400 mg alone, but the relative risk of drowsiness was 3.74 (95% CI 1.03 to 13.56) for the combination. The relative risk of drowsiness for ibuprofen alone was 2.33 (95% CI 1.27 to 4.27). The additive effect of caffeine is inconsistent.

    References

    • Li Wan Po A, Zhang WY. Analgesic efficacy of ibuprofen alone and in combination with codeine or caffeine in post-surgical pain: a meta-analysis. Eur J Clin Pharmacol 1998;53:303-311. [DARE]

Primary/Secondary Keywords