The purpose of this systematic review was to determine the analgesic efficacy and adverse effects of ibuprofen in comparison with other traditional non-opioid analgesics after third molar surgery. A total of 17 full texts were identified in PubMed and assessed using the Cochrane Collabo-ration’s risk of bias tool by two independent researchers. The sum of pain intensity differences, total pain relief, the overall evaluation, the number of patients requiring rescue analgesics, and adverse effects were collected. Data were analyzed using the Review Manager Software 5.3. for Windows. A total of 15 articles met the criteria. The qualitative and quantitative analysis showed that ibuprofen is more effective to relieve post-operative dental pain than acetaminophen, meclofenamate, aceclofenac, bromfenac, and aspirin. Moreover, ibuprofen and traditional non-steroidal anti-inflammatory drugs have a similar safety profile. In conclusion, ibuprofen 400 mg appears to have good analgesic efficacy and a safety profile similar to other traditional non-steroidal anti-inflammatory drugs after third molar surgery.
BACKGROUND: This review is an update of "Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults" last updated in Issue 4, 2009. Ketoprofen is a non-selective nonsteroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. This review is one of a series on oral analgesics for acute postoperative pain. Individual reviews have been brought together in two overviews to provide information about the relative efficacy and harm of the different interventions.
OBJECTIVES: To assess the efficacy and safety of single dose oral ketoprofen and oral dexketoprofen compared with placebo for acute postoperative pain, using methods that permit comparison with other analgesics evaluated in the same way, and criteria of efficacy recommended by an in-depth study at the individual patient level.
SEARCH METHODS: For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from 2009 to 28 March 2017. We also searched the reference lists of retrieved studies and reviews, and two online clinical trial registries.
SELECTION CRITERIA: Randomised, double-blind, placebo-controlled trials of single dose orally administered ketoprofen or dexketoprofen in adults with moderate to severe acute postoperative pain.
DATA COLLECTION AND ANALYSIS: Two review authors independently considered studies for inclusion in the review, examined issues of study quality and potential bias, and extracted data. For dichotomous outcomes, we calculated risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH) with 95% confidence intervals (CI) for ketoprofen and dexketoprofen, compared with placebo, where there were sufficient data. We collected information on the number of participants with at least 50% of the maximum possible pain relief over six hours, the median time to use of rescue medication, and the proportion of participants requiring rescue medication. We also collected information on adverse events and withdrawals. We assessed the quality of the evidence using GRADE, and created 'Summary of findings' tables.
MAIN RESULTS: This updated review included 24 studies; six additional studies added 1001 participants involved in comparisons of ketoprofen or dexketoprofen and placebo, with a 12% increase in participants taking ketoprofen and a 65% increase for dexketoprofen. Most participants (70%) were women. Dental studies typically involved young participants (mean age 20 to 30 years); other types of surgery involved older participants (mean age 37 to 68 years). Overall, we judged the studies at high risk of bias only for small size, which can lead to an overestimation of benefit.Ketoprofen doses ranged between 6.5 mg and 150 mg. The proportion of participants achieving at least 50% pain relief over six hours with the usual ketoprofen oral dose of 50 mg was 57%, compared to 23% with placebo, giving an NNT of 2.9 (95% CI 2.4 to 3.7) (RR 2.5, 95% CI 2.0 to 3.1; 594 participants; 8 studies; high quality evidence). Efficacy was significantly better in dental studies (NNT 1.8) than other surgery (NNT 4.2). The proportion of participants using rescue medication within six hours was lower with ketoprofen (32%) than with placebo (75%), giving a number needed to treat to prevent use of rescue medication (NNTp) of 2.3 (95% CI 1.8 to 3.1); 263 participants; 4 studies; high quality evidence). Median time to remedication estimates were poorly reported. Reports of any adverse event were similar with ketoprofen (18%) and placebo (11%) (RR 1.6, 95% CI 0.98 to 2.8; 342 participants; 5 studies; high quality evidence). No study reported any serious adverse events (very low quality evidence).Dexketoprofen doses ranged between 5 mg and 100 mg. The proportion of participants achieving at least 50% pain relief over six hours with the usual dexketoprofen oral dose of 20 mg or 25 mg was 52%, compared to 27% with placebo, giving an NNT of 4.1 (95% CI 3.3 to 5.2) (RR 2.0, 95% CI 1.6 to 2.2; 1177 participants; 8 studies; high quality evidence). Efficacy was significantly better in dental studies (NNT 2.7) than other surgery (NNT 5.7). The proportion of participants using rescue medication within six hours was lower with ketoprofen (47%) than placebo (69%), giving an NNTp of 4.7 (95% CI 3.3 to 8.0); 445 participants; 5 studies; high quality evidence). Median time to remedication estimates were poorly reported. Reports of any adverse event were similar with dexketoprofen (14%) and placebo (10%) (RR 1.4, 95% CI 0.89 to 2.2; 536 participants, 6 studies; high quality evidence). No study reported any serious adverse events (very low quality evidence).
AUTHORS' CONCLUSIONS: Ketoprofen at doses of 25 mg to 100 mg is an effective analgesic in moderate to severe acute postoperative pain with an NNT for at least 50% pain relief of 2.9 with a 50 mg dose. This is similar to that of commonly used NSAIDs such as ibuprofen (NNT 2.5 for 400 mg dose) and diclofenac (NNT 2.7 for 50 mg dose). Dexketoprofen is also effective with an NNT of 4.1 in the dose range 10 mg to 25 mg. Differential efficacy between dental surgery and other types of surgery seen for both drugs is unusual. Both drugs were well tolerated in single doses.
HINTERGRUND: Diese Rezension Updates ein Cochrane-Review 1999 zeigen, dass Ibuprofen in verschiedenen Dosen wirksam war, in der postoperativen Schmerztherapie in Einzeldosis-Studien entwickelt, um analgetische Wirksamkeit zu demonstrieren. Neue Studien wurden seitdem veröffentlicht. Ibuprofen ist eine der am häufigsten eingesetzte nicht-steroidale entzündungshemmende (NSAID) Analgetika sowohl durch die Verschreibung und als Over-the-Counter-Medizin. Ibuprofen wird bei akuten und chronischen Schmerzzuständen eingesetzt.
ZIELE: Die analgetische Wirksamkeit von Ibuprofen in oralen Einzeldosen von mittelschweren bis schweren postoperativen Schmerzen bei Erwachsenen zu bewerten.
Suchstrategien gesucht Cochrane CENTRAL, MEDLINE, EMBASE und der Oxford Pain Relief Database für Studien bis Mai 2009.
Auswahlkriterien Ausgewählt wurden randomisierte, doppelblinde, Placebo-kontrollierten Studien der Einzeldosis oral Ibuprofen (jede Formulierung) bei Erwachsenen verabreicht mit mittelschwerem bis schwerem akuten postoperativen Schmerzen.
Datensammlung und-analyse: Zwei Rezension Autoren unabhängig voneinander die Studienqualität bewertet und extrahierten Daten. Schmerzlinderung oder Schmerzintensität Daten wurden extrahiert und in die dichotome Ergebnis der Anzahl der Teilnehmer umgesetzt mit mindestens 50% ige Schmerzlinderung über 4 bis 6 Stunden, von dem relativen Risiko und Zahl-needed-to-Treat-to-Nutzen (NNT) berechnet. Die Zahl der Teilnehmer mit Notfallmedikation über bestimmte Zeiträume zu, und Zeit, um von Rescue-Medikation zu verwenden, wurden als weitere Maßnahmen der Wirksamkeit gesucht. Informationen über unerwünschte Ereignisse und Auszahlungen wurden gesammelt.
Hauptresultate Zweiundsiebzig Studien verglichen Ibuprofen und Placebo (9.186 Teilnehmer). Studien waren überwiegend von hoher Qualität der Berichterstattung, und der Großteil der betreffenden Informationen Ibuprofen 200 mg und 400 mg. Für mindestens 50% ige Schmerzlinderung im Vergleich zu Placebo die NNT für Ibuprofen 200 mg (2.690 Teilnehmer) lag bei 2,7 (2,5-3,0) und für Ibuprofen 400 mg (6.475 Teilnehmer) war es 2,5 (2,4-2,6). Der Anteil mit mindestens 50% ige Schmerzlinderung betrug 46% mit 200 mg und 54% mit 400 mg. Remedication innerhalb von 6 Stunden war weniger häufig mit höheren Dosen, mit 48% remedicating mit 200 mg und 42% mit 400 mg. Die mediane Zeit bis remedication war 4,7 Stunden mit 200 mg und 5,4 Stunden mit 400 mg. Die Sensitivitätsanalyse zeigte, dass Schmerzen und Ibuprofen-Modell kann sowohl Einfluss auf das Ergebnis, mit zahnärztlichen Impaktion Modelle und lösliche Salze Ibuprofen Herstellung besserer Wirksamkeit Schätzungen. Die unerwünschten Ereignisse waren selten, und unterscheidet sich nicht von Plazebo.
SCHLUSSFOLGERUNGEN DER AUTOREN: Die sehr hohen Betrag von hoher Qualität Beweise zeigen, dass Ibuprofen eine wirksame analgetische Behandlung von postoperativen Schmerzen ist. NNT für 200 mg und 400 mg Ibuprofen änderten sich nicht signifikant von der vorherigen Kritik, auch wenn eine beträchtliche Menge an neuen Informationen hinzugefügt wurde. Neue Informationen werden auf remedication zur Verfügung gestellt.
The purpose of this systematic review was to determine the analgesic efficacy and adverse effects of ibuprofen in comparison with other traditional non-opioid analgesics after third molar surgery. A total of 17 full texts were identified in PubMed and assessed using the Cochrane Collabo-ration’s risk of bias tool by two independent researchers. The sum of pain intensity differences, total pain relief, the overall evaluation, the number of patients requiring rescue analgesics, and adverse effects were collected. Data were analyzed using the Review Manager Software 5.3. for Windows. A total of 15 articles met the criteria. The qualitative and quantitative analysis showed that ibuprofen is more effective to relieve post-operative dental pain than acetaminophen, meclofenamate, aceclofenac, bromfenac, and aspirin. Moreover, ibuprofen and traditional non-steroidal anti-inflammatory drugs have a similar safety profile. In conclusion, ibuprofen 400 mg appears to have good analgesic efficacy and a safety profile similar to other traditional non-steroidal anti-inflammatory drugs after third molar surgery.
