A Cochrane review [Abstract] 1 included 20 studies with a total of 2 641 subjects. Most data are available for oxycodone 10 mg plus paracetamol 650 mg, with over 1000 participants. No benefit could be shown of oxycodone 5 mg alone over placebo, but oxycodone 15 mg was superior to placebo with NNT for at least 50% pain relief over 4 to 6 hours compared to placebo of 4.6 (2.9 to 11) based on 2 studies. About half of the participants treated with oxycodone 15 mg achieved at least 50% pain relief, compared with about a third treated with placebo. There were insufficient data for analysis of oxycodone 10 mg. For oxycodone 10 mg plus paracetamol 650 mg, the NNT was 2.7 (2.4 to 3.1) based on 10 studies. Proportion of participants achieving at least 50% pain relief was 51% in the oxycodone+paracetamol group and 14% in the placebo group. A dose response was demonstrated for this outcome with combination therapy. Duration of effect was 10 hours with oxycodone 10 mg plus paracetamol 650 mg, and 4 hours with half that dose. Fewer participants needed rescue medication over 6 hours at the higher dose.
Adverse events (predominantly nausea, vomiting, dizziness and somnolence) occurred more frequently with oxycodone and combination therapy than placebo, but were generally described as mild to moderate in severity and rarely led to withdrawal.
Indirect comparisons of NNTs in reviews of other analgesics using identical methods indicate that oxycodone 10 mg plus paracetamol 650 mg has equivalent efficacy to naproxen 500 mg, ibuprofen 400 mg, lumiracoxib 400 mg and celecoxib 400 mg and is better than paracetamol 1000 mg.
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