Single dose oral ibuprofen for acute postoperative pain in adults

  • Review
  • Intervention

Authors


Maura Moore, Pain Research and Nuffield Department of Anaesthetics, University of Oxford, West Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, OX3 9DU, UK. maura.moore@pru.ox.ac.uk.

Abstract

Background

Ibuprofen and diclofenac are two widely used non-steroidal anti-inflammatory (NSAID) analgesics. It is therefore important to know which drug should be recommended for postoperative pain relief. This review seeks to compare the relative efficacy of the two drugs, and also considers the issues of safety and cost.

Objectives

To assess the analgesic efficacy of ibuprofen and diclofenac in single oral doses for moderate to severe postoperative pain.

Search methods

Randomised trials were identified by searching Medline (1966 to December 1996), Embase (1980 to January 1997), The Cochrane Library (Issue 3 1996), Biological Abstracts (January 1985 to December 1996) and the Oxford Pain Relief Database (1950 to 1994). Date of the most recent searches: July 1998.

Selection criteria

The inclusion criteria used were: full journal publication, postoperative pain, postoperative oral administration, adult patients, baseline pain of moderate to severe intensity, double-blind design, and random allocation to treatment groups which compared either ibuprofen or diclofenac with placebo.

Data collection and analysis

Data were extracted by two independent reviewers, and trials were quality scored.

Summed pain relief or pain intensity difference over four to six hours was extracted, and converted into dichotomous information yielding the number of patients with at least 50% pain relief. This was then used to calculate the relative benefit and the number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief.

Main results

Thirty-four trials compared ibuprofen and placebo (3591 patients), six compared diclofenac with placebo (840 patients) and there were two direct comparisons of diclofenac 50 mg and ibuprofen 400 mg (130 patients). In postoperative pain the NNTs for ibuprofen 200 mg were 3.3 (95% confidence interval 2.8 to 4.0) compared with placebo, for ibuprofen 400 mg 2.7 (2.5 to 3.0), for ibuprofen 600 mg 2.4 (1.9 to 3.3), for diclofenac 50 mg 2.3 (2.0 to 2.7) and for diclofenac 100 mg 1.8 (1.5 to 2.1).

Direct comparisons of diclofenac 50 mg with ibuprofen 400 mg showed no significant difference between the two.

Authors' conclusions

Both drugs work well. Choosing between them is an issue of dose, safety and cost.

Plain language summary

Single dose oral ibuprofen for postoperative pain

Ibuprofen and diclofenac are two widely used non-steroidal anti-inflammatory (NSAID) analgesics. This review seeks to compare the relative efficacy of the two drugs, and also considers the issues of safety and cost. The results confirm that both ibuprofen and diclofenac are effective analgesics for postoperative pain with a low incidence of adverse effects. This analysis indicates there is no real difference between the single dose efficacy of ibuprofen and diclofenac. The relative efficacy of the two drugs comes down to dose, 50 mg of diclofenac may provide better analgesia than 400 mg of ibuprofen but it is one third of the maximum daily dose whereas ibuprofen 400 mg is only one sixth. At 600 mg ibuprofen appears to work as well as diclofenac 50 mg yet the dose is still a lower proportion of the maximum daily allowance. Choosing between them therefore appears to be a matter of dose, safety and cost. Ibuprofen has been reported as having a lower incidence of adverse effect but this again may be a reflection of the dosage used, it is also usually cheaper.

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