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Systematic review

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Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis.

Zeitung Journal of dental research
Year 2023
Links Pubmed DOI PubMed Central

Dieser Artikel enthält 83 Primary studies 85 Primary studies (83 references)

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This study compares the effectiveness of pharmacological treatments to develop guidelines for the management of acute pain after tooth extraction. We searched Medline, EMBASE, CENTRAL, and US Clinical Trials registry on November 21, 2020. We included randomized clinical trials (RCTs) of participants undergoing dental extractions comparing 10 interventions, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations to placebo. After duplicate screening and data abstraction, we conducted a frequentist network meta-analysis for each outcome at 6 h (i.e., pain relief, total pain relief [TOTPAR], summed pain intensity difference [SPID], global efficacy rating, rescue analgesia, and adverse effects). We assessed the risk of bias using a modified Cochrane RoB 2.0 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We implemented the analyses in RStudio version 3.5.3 and classified interventions from most to least beneficial or harmful. We included 82 RCTs. Fifty-six RCTs enrolling 9,095 participants found moderate- and high-certainty evidence that ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg (mean difference compared to placebo [MDp], 1.68; 95% confidence interval [CI], 1.06-2.31), acetaminophen 650 mg plus oxycodone 10 mg (MDp, 1.19; 95% CI, 0.85-1.54), ibuprofen 400 mg (MDp, 1.31; 95% CI, 1.17-1.45), and naproxen 400-440 mg (MDp, 1.44; 95% CI, 1.07-1.80) were most effective for pain relief on a 0 to 4 scale. Oxycodone 5 mg, codeine 60 mg, and tramadol 37.5 mg plus acetaminophen 325 mg were no better than placebo. The results for TOTPAR, SPID, global efficacy rating, and rescue analgesia were similar. Based on low- and very low-certainty evidence, most interventions were classified as no more harmful than placebo for most adverse effects. Based on moderate- and high-certainty evidence, NSAIDs with or without acetaminophen result in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo.

Systematic review

Unclassified

Pain Relief with Combination Acetaminophen/Codeine or Ibuprofen following Third-Molar Extraction: A Systematic Review and Meta-Analysis.

Autoren Watson H , Hildebolt C , Rowland K
Zeitung Pain medicine (Malden, Mass.)
Year 2022
Links Pubmed DOI

Dieser Artikel enthält 15 Primary studies 15 Primary studies (15 references)

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Objective The purpose of our study was to perform a systematic review and meta-analysis of randomized, blinded, placebo-controlled studies that, following third-molar extraction, utilized either a combination of acetaminophen (600 mg) with codeine (60 mg) or ibuprofen (400 mg) for pain management. Design We searched PubMed, and the trial registry ClinicalTrials.gov databases with the keywords "molar or molars," "tooth or teeth," "extraction," and "pain." Selected studies were: (1) randomized, blinded, placebo controlled, (2) utilized either a single-dose combination acetaminophen (600 mg) with codeine (60 mg) (A/C) or ibuprofen, and (3) recorded standardized pain relief (PR) at 6 hours, or summed total pain relief over 6 hours (TOTPAR6). Of the 2,949 articles that were identified, 79 were retrieved for full-text analysis, and 20 of these studies met our inclusion criteria. Results For A/C, the weighted, standardized mean difference (SMD) for TOTPAR6 was 0.796 (95% confidence interval [CI], 0.597–0.995), P < .001, and for PR at 6 hours, the SMD was 0.0186 (0.007 to 0.378; P = .059), whereas for ibuprofen the SMD for TOTPAR6 was 3.009 (1.283 to 4.735; P = .001), and for PR at 6 hours, the SMD was 0.854 (95% CI, 0.712–0.996; P < .001). A SMD of 0.8 or larger is indicative of a large effect. Conclusions Our data indicate that single dose of ibuprofen (400 mg) is an effective pain reducer for post third molar extraction pain.

Systematic review

Unclassified

Efficacy and safety of selective COX-2 inhibitors for pain management after third molar removal: a meta-analysis of randomized clinical trials

Zeitung Clinical oral investigations
Year 2020
Links Pubmed DOI

Dieser Artikel enthält 12 Primary studies 12 Primary studies (12 references)

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Objectives: To compare selective COX-2 inhibitors with ibuprofen in terms of analgesia, rescue medication consumption, and adverse effects after impacted third molar removal. Materials and methods: Electronic databases were searched. Single dose, double-blind, randomized, and controlled clinical trials comparing the analgesic effect of a selective COX-2 inhibitor versus at least one active control group using ibuprofen after impacted third molar removal were selected. Results: Twelve studies were included for the qualitative synthesis and eight were included in the meta-analysis. No statistically significant differences were found between selective COX-2 inhibitors and ibuprofen in terms of pain relief after 6, 8, and 12 h. Rescue analgesia use after 24 h was significantly greater in the ibuprofen group than in the selective COX-2 inhibitor group. There were no statistically significant differences in the number of patients presenting one or more adverse events between the two groups, though ibuprofen intake was related with more nausea and vomiting. Conclusions: No statistically significant differences were found in terms of pain relief 6, 8, and 12 h post-medication between selective COX-2 inhibitors and ibuprofen following totally or partially impacted third molar removal. The patients who consumed selective COX-2 inhibitors needed less rescue analgesia after 24 h. The occurrence of one or more adverse events was similar in both groups, though patients who consumed ibuprofen had more nausea and vomiting. Clinical relevance: COX-2 inhibitors could be considered a suitable alternative to ibuprofen for pain relief after third molar extraction in patients at risk of developing nausea and vomiting. Also, COX-2 inhibitors seem to slightly reduce the need of rescue medication consumption. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Systematic review

Unclassified

Use of opioid analgesics after third molar extraction: a review of scientific literature

Zeitung Arq. odontol
Year 2017
Links LILACS

Dieser Artikel enthält 9 Primary studies 9 Primary studies (9 references)

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Aim: This study aims to perform a literature review that reports on the use of opioid analgesics and their efficacy after extracting third molars, comparing them with other types of drugs. Methods: The search of articles in the PubMed database was carried out from 2006 to 2016, resulting in a total of 131 articles. Of these, 122 articles that did not report the use of opioids that were not from the Dentistry area, or that did not report the use of opioids after the extraction of third molars, were excluded. Literature reviews or non-comparative articles were also excluded. Thus, 9 articles were considered and incorporated into the review. Results: This review identified some clinical trials comparing the use of opioid analgesics with other drug options. From the trials comparing opioid analgesics with other NSAIDs (N = 3), with no drug combinations, NSAIDs proved to be more effective or, in the case of preemptive analgesia, had the same effect. Studies comparing the association of opioid analgesics with NSAIDs (N = 4) have shown that the association is more beneficial than the use of opioids alone. A single study that tested the association between opioids and corticosteroids has shown that this association is more effective than the association between opioids and NSAIDs. One study, which tested the association between opioids and paracetamol with NSAIDs concluded that the efficacy was similar between groups. Conclusion: Opioid analgesics are generally less effective than NSAIDs in controlling pain after the extraction of third molars. Its association with NSAIDs is recommended in some clinical situations. The use of opioids as the first choice seems to be restricted to patients with a contraindication to the use of NSAIDs.(AU)

Systematic review

Unclassified

Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults

Zeitung Cochrane Database of Systematic Reviews
Year 2017
Links Pubmed DOI PubMed Central

Dieser Artikel ist in enthalten 1 Broad synthesis 12 Broad syntheses (1 reference)

Dieser Artikel enthält 12 Primary studies 12 Primary studies (12 references)

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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.

Systematic review

Unclassified

Single dose oral diclofenac for acute postoperative pain in adults.

Autoren Derry S , Wiffen PJ , Moore RA
Zeitung Cochrane Database of Systematic Reviews
Year 2015
Links Pubmed DOI PubMed Central

Dieser Artikel ist in enthalten 2 Broad syntheses 16 Broad syntheses (2 references)

Dieser Artikel enthält 16 Primary studies 16 Primary studies (16 references)

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BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug, available as a potassium salt (immediate release) or sodium salt (enteric coated to suppress dissolution in the stomach). This review updates an earlier review published in the Cochrane Database of Systematic Reviews (Issue 2, 2009) entitled 'Single dose oral diclofenac for acute postoperative pain in adults'. OBJECTIVES: To assess the analgesic efficacy and adverse effects of a single oral dose of diclofenac for moderate to severe postoperative pain, using methods that permit comparison with other analgesics evaluated in standardised trials using almost identical methods and outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Relief Database, two clinical trial registries, and the reference lists of articles. The date of the most recent search was 9 March 2015. SELECTION CRITERIA: Randomised, double-blind, placebo-controlled clinical trials of single dose, oral diclofenac (sodium or potassium) for acute postoperative pain in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently considered studies for inclusion in the review, assessed risk of bias, and extracted data. We used the area under the pain relief versus time curve to derive the proportion of participants with at least 50% pain relief over six hours prescribed either diclofenac or placebo. We calculated the risk ratio (RR) and number needed to treat to benefit (NNT). We used information on the use of rescue medication to calculate the proportion of participants requiring rescue medication and the weighted mean of the median time to use. We also collected information on adverse effects. MAIN RESULTS: This update included three new studies, providing a 26% increase in participants in comparisons between diclofenac and placebo. We included 18 studies involving 3714 participants, 1902 treated with diclofenac and 1007 with placebo. This update has also changed the focus of the review, examining the effects of formulation in more detail than previously. This is a result of increased understanding of the importance of speed of onset in determining analgesic efficacy in acute pain.The largest body of information, for 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% confidence interval (CI) 1.9 to 2.5) (high quality evidence). 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 (moderate quality evidence). AUTHORS' CONCLUSIONS: Diclofenac potassium provides good pain relief at 25 mg, 50 mg, and 100 mg doses. Diclofenac sodium has limited efficacy and should probably not be used in acute pain.

Systematic review

Unclassified

Pain Management for Elective Foot and Ankle Surgery: A Systematic Review of Randomized Controlled Trials.

Autoren Wang J , Liu GT , Mayo HG , Joshi GP
Zeitung The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
Year 2015
Links Pubmed DOI

Dieser Artikel enthält 45 Primary studies 45 Primary studies (45 references)

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Pain after foot and ankle surgery can significantly affect the postoperative outcomes. We performed a systematic review of randomized controlled trials assessing postoperative pain after foot and ankle surgery, because the surgery will lead to moderate-to-severe postoperative pain, but the optimal pain therapy has been controversial. A systematic review of randomized controlled trials in English reporting on pain after foot and ankle surgery in adults published from January 1946 to February 2013 was performed. The primary outcome measure was the postoperative pain scores. The secondary outcome measures included supplemental analgesic requirements and other recovery outcomes. With 953 studies identified, 45 met the inclusion criteria. The approaches improving pain relief (reduced pain scores or opioid requirements) included peripheral nerve blocks, wound infiltration, intravenous dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 selective inhibitors, and opioids. Wound instillation, intra-articular injection, and intravenous regional analgesia had variable analgesia. The lack of homogeneous study design precluded quantitative analyses. Optimal pain management strategies included locoregional analgesic techniques plus acetaminophen and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors, with opioids used for “rescue,” and 1 intraoperative dose of parenteral dexamethasone. Popliteal sciatic nerve blocks would be appropriate when expecting severe postoperative pain (extensive surgical procedure), and ankle blocks and surgical incision infiltration would be appropriate when expecting moderate postoperative pain (less extensive and minimally invasive surgical procedures). Additional studies are needed to assess multimodal analgesia techniques.

Systematic review

Unclassified

Einzel-Dosis oral Celecoxib bei akuten postoperativen Schmerzen bei Erwachsenen.

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Autoren Derry S , Moore RA
Zeitung Cochrane Database of Systematic Reviews
Year 2013
Links Pubmed DOI PubMed Central

Dieser Artikel ist in enthalten 1 Broad synthesis 9 Broad syntheses (1 reference)

Dieser Artikel enthält 9 Primary studies 9 Primary studies (9 references)

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HINTERGRUND: Dies ist ein Update von einer Überprüfung zunächst in der Cochrane Library in Ausgabe 4, 2008 veröffentlicht und aktualisiert in Ausgabe 3, 2012. Celecoxib ist ein selektiver Cyclooxygenase-2 (COX-2)-Hemmer in der Regel für die Linderung von chronischen Schmerzen bei Arthrose und rheumatoider Arthritis verschrieben. Celecoxib wird angenommen, dass mit weniger obere gastrointestinale Nebenwirkungen als herkömmliche nicht-steroidale entzündungshemmende Medikamente (NSAIDs) zugeordnet werden. Seine Wirksamkeit bei akuten Schmerzen wurde in den früheren Bewertungen demonstriert. ZIELE: Um analgetische Wirksamkeit und Nebenwirkungen einer oralen Dosis von Celecoxib für mittelschwere bis schwere postoperative Schmerzen bei Erwachsenen zu beurteilen. Suchmethoden: Wir suchten die Cochrane Zentralregister of Controlled Trials (CENTRAL), MEDLINE, EMBASE, die Oxford Schmerz Database und ClinicalTrials.gov. Die jüngste Suche war bis zum 31. Mai 2013 übermittelt. Auswahlkriterien: Wir enthalten randomisierten, doppelt-verblindeten, Placebo-kontrollierten Studien (RCT) der Erwachsenen verschrieben jede Dosis von oral Celecoxib oder Placebo bei akuten postoperativen Schmerzen. Datensammlung und-analyse: Zwei Rezension Autoren beurteilt Studien für Qualität und extrahierten Daten. Wir umgewandelt summierten Schmerzlinderung (TOTPAR) oder Schmerzintensitätsdifferenz (SPID) in dichotome Informationen, was die Zahl der Teilnehmer mit mindestens 50% Schmerzlinderung über vier bis sechs Stunden. Wir nutzten diese, um die relative Leistung (RB) und number needed to treat zu profitieren (NNT), für einen Patienten um mindestens 50% der maximalen Schmerzlinderung mit Celecoxib die dies nicht getan würde so mit Placebo haben erreichen berechnen. Wir haben Informationen über die Verwendung von Rescue-Medikation, um den Anteil der Teilnehmer erfordern Notfallmedikation und der gewichtete Mittelwert der medianen Zeit bis zum verwenden zu berechnen. MAIN ERGEBNISSE: Zehn Studien (1785 Teilnehmer) erfüllten die Einschlusskriterien. Die beiden neuen Studien in diesem Update war in der früheren Update identifiziert worden, aber die Daten waren nicht verfügbar. Es bleiben drei potenziell relevante unveröffentlichte Studien, für die Daten zu diesem Zeitpunkt nicht zur Verfügung.Die NNT für Celecoxib 200 mg und 400 mg im Vergleich zu Placebo für mindestens 50% der maximalen Schmerzlinderung über vier bis sechs Stunden betrug 4,2 (95% Konfidenzintervall (CI) von 3,4 bis 5,6) und 2,6 (95% CI 2,3 bis 3,0) sind. Die mediane Zeit bis der Rescue-Medikation nutzen betrug 6,6 Stunden bei 200 mg Celecoxib, 8,4 Stunden mit Celecoxib 400 mg und 2,3 Stunden lang mit Placebo. Der Anteil der Teilnehmer erfordern Notfallmedikation über 24 Stunden betrug 74% mit Celecoxib 200 mg, 63% für Celecoxib 400 mg, und 91% für Placebo. Die NNT, um einem Patienten mit Notfallmedikation verhindern betrug 4,8 (95% CI 3,5-7,7) und 3,5 (95% CI 2,9-4,6) für Celecoxib 200 mg und 400 mg. Unerwünschte Ereignisse waren im Allgemeinen leicht bis mäßig ausgeprägt und wurden nach einem ähnlichen Anteil der Teilnehmer in der Celecoxib-und Placebo-Gruppen erlebt. Eine schwerwiegende unerwünschte Ereignis, das wahrscheinlich im Zusammenhang Celecoxib war gemeldet wurde. Schlussfolgerungen der Autoren: Single-Dosis oral Celecoxib ist ein wirksames Analgetikum zur postoperativen Schmerzlinderung. Indirekte Vergleich legt nahe, dass die 400-mg-Dosis ähnliche Wirksamkeit zu Ibuprofen 400 mg hat.

Systematic review

Unclassified

Lumiracoxib bei akuten postoperativen Zahnschmerzen: eine systematische Überprüfung der randomisierten klinischen Studien.

automatic
Autoren Silva RC , Riera R , Saconato H
Zeitung São Paulo medical journal = Revista paulista de medicina
Year 2011
Links Pubmed DOI LILACS

Dieser Artikel enthält 3 Primary studies 3 Primary studies (3 references)

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HINTERGRUND UND ZIEL: Lumiracoxib ist ein entzündungshemmendes Medikament, das verwendet wurde, um akute Zahnschmerzen zu behandeln, vor allem in der postoperativen Einstellungen, in denen die größten Mengen an Schmerzen und Beschwerden während der ersten 24 Stunden erlebt. Diese Studie soll die Wirksamkeit und Sicherheit von Lumiracoxib zur Behandlung von akuten postoperativen Zahnschmerzen zu beurteilen. DESIGN UND EINSTELLUNG: Systematische Überprüfung bei der brasilianischen Cochrane Centre, Universidade Federal de São Paulo entwickelt. METHODEN: Eine elektronische Suche wurde in der PubMed, Cochrane Library, Flieder (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Library Online) und Embase-Datenbanken durchgeführt. Eine manuelle Suche wurde ebenfalls durchgeführt. Nur randomisierte kontrollierte Studien wurden einbezogen, und diese wurden ausgewählt und im Hinblick auf die Gefahr der Befangenheit von zwei Forschern bewertet. Ergebnisse: Drei klinische Studien mit 921 Teilnehmern wurden eingeschlossen. Lumiracoxib 400 mg zu Beginn der Analgesie in einer kürzeren Zeit als durch Lumiracoxib 100 mg, 200 mg Celecoxib und Ibuprofen 400 mg dargestellt. Es gab keinen Unterschied zwischen Lumiracoxib 400 mg und 50 mg Rofecoxib. In beiden Studien wurde die mittlere Zeit bis zum Beginn der Analgesie bei der Placebo erreichen nicht geschätzt, da die Anzahl von Teilnehmern, Anfang erreicht war zu klein. FAZIT: Es gibt Hinweise, mit einem mäßigen Risiko für Bias, die die Verwendung von Lumiracoxib bei akuten postoperativen Zahnschmerzen empfiehlt. Jedoch sind die Nebenwirkungen nicht vollständig bekannt. Da Lumiracoxib ist derzeit nur in drei Ländern verfügbar ist, sind weitere Untersuchungen wahrscheinlich selten und entmutigt zu sein.

Systematic review

Unclassified

Einzeldosis oral Lumiracoxib für postoperative Schmerzen bei Erwachsenen

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Autoren Roy YM , Derry S , Moore RA
Zeitung Cochrane database of systematic reviews (Online)
Year 2010
Links Pubmed DOI PubMed Central

Dieser Artikel ist in enthalten 1 Broad synthesis 4 Broad syntheses (1 reference)

Dieser Artikel enthält 4 Primary studies 4 Primary studies (4 references)

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HINTERGRUND: Lumiracoxib ist ein selektiver Cyclooxygenase-2 (COX-2)-Hemmer. COX-2 Inhibitoren wurden entwickelt, um COX-1-verwandten gastrointestinalen (GI) Probleme zu vermeiden und gleichzeitig die schmerzlindernde und entzündungshemmende Wirkung der traditionellen nicht-steroidalen Antiphlogistika (NSAIDs). ZIELE: Um die analgetische Wirksamkeit, Dauer der Analgesie und Nebenwirkungen von einer einzigen oralen Dosis von Lumiracoxib bei mittleren bis schweren postoperativen Schmerzen bei Erwachsenen zu überprüfen. Suchstrategien gesucht Cochrane CENTRAL, MEDLINE, EMBASE und bis Februar 2010. Auswahlkriterien: einzelne orale Dosis, randomisierte, doppel-blinde, Placebo-kontrollierten Studien von Lumiracoxib zur Linderung von etablierten moderaten bis starken postoperativen Schmerzen bei Erwachsenen. Datensammlung und-analyse: Die Studien wurden für die methodische Qualität und die Daten von zwei Autoren extrahierten unabhängig voneinander Kritik beurteilt. Gesamtsumme Schmerzlinderung über sechs Stunden (TOTPAR 6) wurde verwendet, um die Anzahl der Teilnehmer dem Ziel, mindestens 50% ige Schmerzlinderung zu berechnen. Diese abgeleiteten Ergebnisse wurden verwendet, um zu berechnen, mit 95% Konfidenzintervall, der relative Nutzen im Vergleich zu Placebo, und die number needed to treat (NNT) für eine Person für mindestens 50% ige Schmerzlinderung über sechs Stunden zu erleben. Die Zahl der Teilnehmer mit Rescue-Medikation, und Zeit, um von Rescue-Medikation zu verwenden, wurden als weitere Maßnahmen der Wirksamkeit gesucht. Informationen über unerwünschte Ereignisse und Auszahlungen gesammelt wurde. Hauptresultate In dieser aktualisierten Rezension vier Studien erfüllten die Einschlusskriterien. Insgesamt 366 Teilnehmer wurden mit 400 mg Lumiracoxib, 51 mit Lumiracoxib 100 mg und 212 mit Placebo behandelt wurden. Aktive Komparatoren waren Naproxen 500 mg, 50 mg Rofecoxib, Celecoxib 200 mg, 400 mg Celecoxib und Ibuprofen 400 mg. Mit Lumiracoxib 400 mg 50% der Teilnehmer hatten mindestens 50% ige Schmerzlinderung über sechs Stunden, verglichen mit 8% unter Plazebo; RB 6,9 (95% CI 4,1 bis 12), NNT 2,4 (2,1-2,8). Die mediane Zeit bis zum Einsetzen der Analgesie war kürzer für Lumiracoxib 400 mg (0,6 bis 1,5 Stunden) als bei Placebo (> 12 Stunden). Weniger Teilnehmer benötigt Notfallmedikation mit Lumiracoxib (64%) als unter Placebo (91%) über 12 bis 24 Stunden; NNT zu remedication 3,7 (2,9-5,0) zu verhindern. Die gewichtete mittlere Zeit bis zum von Notfallmedikation war 9,4 Stunden für Lumiracoxib 400 mg und 1,7 Stunden für Placebo. Die Nebenwirkungen waren im Allgemeinen leicht bis mittelschwer, mit einem einzigen schweren Vorfall in einer Placebo Patienten berichtet. SCHLUSSFOLGERUNGEN DER AUTOREN: Lumiracoxib 400 mg als einzelne orale Dosis ist ein wirksames Analgetikum bei akuten postoperativen Schmerzen, und hat eine relativ lange Wirkungsdauer. Unerwünschte Ereignisse mit Lumiracoxib nicht von Placebo unterscheiden.