Paracetamol for pain relief after surgical removal of lower wisdom teeth

 

Abstract

Background

Paracetamol has been commonly used for the relief of postoperative pain following oral surgery. In this review we investigated the optimal dose of paracetamol and the optimal time for drug administration to provide pain relief, taking into account the side effects of different doses of the drug. This will inform dentists and their patients of the best strategy for pain relief after the surgical removal of wisdom teeth.

Objectives

To assess the beneficial and harmful effects of paracetamol for pain relief after surgical removal of lower wisdom teeth, compared to placebo, at different doses and administered postoperatively.

Search methods

We searched the Cochrane Oral Health Group's Trials Register; the Cochrane Pain, Palliative and Supportive Care Group's Trials Register; CENTRAL; MEDLINE; EMBASE and the Current Controlled Trials Register. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomised controlled trials (RCTs), to manufacturers of analgesic pharmaceuticals, we searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 24th August 2006.

Selection criteria

Randomised, parallel group, placebo controlled, double blind clinical trials of paracetamol for acute pain, following third molar surgery.

Data collection and analysis

All trials identified were scanned independently and in duplicate by two review authors, any disagreements were resolved by discussion, or if necessary a third review author was consulted. The proportion of patients with at least 50% pain relief was calculated for both paracetamol and placebo. The number of patients experiencing adverse events, and/or the total number of adverse events reported were analysed.

Main results

Twenty-one trials met the inclusion criteria. A total of 2048 patients were initially enrolled in the trials (1148 received paracetamol, and 892 the placebo) and of these 1968 (96%) were included in the meta-analysis (1133 received paracetamol, and 835 the placebo). Paracetamol provided a statistically significant benefit when compared with placebo for pain relief and pain intensity at both 4 and 6 hours. Most studies were found to have moderate risk of bias, with poorly reported allocation concealment being the main problem. Risk ratio values for pain relief at 4 hours 2.85 (95% confidence interval (CI) 1.89 to 4.29), and at 6 hours 3.32 (95% CI 1.88 to 5.87). A statistically significant benefit was also found between up to 1000 mg and 1000 mg doses, the higher the dose giving greater benefit for each measure at both time points. There was no statistically significant difference between the number of patients who reported adverse events, overall this being 19% in the paracetamol group and 16% in the placebo group.

Authors' conclusions

Paracetamol is a safe, effective drug for the treatment of postoperative pain following the surgical removal of lower wisdom teeth.

 

Plain language summary

Paracetamol for pain relief after surgical removal of lower wisdom teeth

The surgical removal of wisdom teeth (third molars) is the most commonly performed surgical procedure undertaken in oral surgery practice. Postoperative complications may include swelling, bruising and limited mouth opening but patients are most often concerned about postoperative pain, which may be severe. Paracetamol is effective in relieving pain with a low incidence of adverse effects. It is one of the most commonly used analgesics and is widely available without prescription around the world. In this review we investigated the optimal dose of paracetamol and the optimal time for drug administration to provide pain relief after the surgical removal of wisdom teeth. The side effects of different doses of the drug were also explored.

Twenty-one trials (with over 2000 participants) were included. Paracetamol provided a statistically significant benefit when compared with placebo for pain relief at both 4 and 6 hours after taking the drug. It is most effective at 1000 mg dose, and can be taken at six hourly intervals without compromising safety. There was no statistically significant difference between the number of patients who reported adverse events, overall this being 19% in the paracetamol group and 16% in the placebo group. It should be noted that most of the studies were found to have some limitations mainly due to poor reporting of information. However the review concludes that paracetamol is a safe, effective drug for the treatment of postoperative pain following the surgical removal of lower wisdom teeth.

 

摘要

背景

使用paracetamol來緩解下顎智齒拔除後的疼痛

Paracetamol已被廣泛使用在口腔手術後的疼痛緩解.在這篇回顧的論文中我們考慮paracetamol在不同劑量時的副作用,研究理想的劑量和藥物給予的時間,來達到疼痛緩解的效果.提供牙醫師及患者在智齒拔除後疼痛緩解最好的用藥資訊.

目標

使用安慰劑和paracetamol,在不同劑量和術後不同的給予方式下,評估paracetamol對於智齒拔除手術後的疼痛緩解有益的和有害的作用.

搜尋策略

搜尋the Cochrane Oral Health Group's Trials Register;the Cochrane Pain, Palliative and Supportive Care Group's Trials Register; CENTRAL; MEDLINE; EMBASE and the Current Controlled Trials Register,包括一些牙科期刊,核對有關的臨床試驗和回顧的論文.寫信給這些隨機對照試驗(randomised controlled trials; RCTs)作者,止痛藥物的製造業者,搜尋私人的參考文獻,企圖去確認未發表的或是進行中的隨機對照實驗.沒有語言的限制,最近的一次電子搜索是2006年8月24日.

選擇標準

隨機選擇,對應組,使用安慰劑的控制組,使用paracetamol來治療智齒拔除後發生急性疼痛的雙盲臨床試驗.

資料收集與分析

分別瀏覽所有已確認的試驗並由兩位複審的作者複寫成一式兩份,任何爭議都藉由討論來解釋,或有需要的話,請教第三位複審的作者. Paracetamol和安慰劑都可以讓至少50%的病人疼痛緩解.分析病人發生副作用的數目和/或被報告出有副作用的全部數目.

主要結論

21個符合準則的試驗,一開始總共有2048位病人參與(1148位病人使用paracetamol, 892位使用安慰劑),整合分析其中的1968(96%)位病人(1133位使用paracetamol, 835位使用安慰劑).結果顯示出paracetamol相較於安慰劑對於疼痛緩解及4和6小時的疼痛強度在統計上有明顯的改善.大部分的研究存在的問題是缺乏完整的報告而有所隱瞞,有某些程度的偏見.4個小時後疼痛緩解的風險比值是2.85(95%信賴區間位於1.89至4.29),6個小時後是3.32(95%信賴區間位於1.88至5.87).使用小於1000毫克和1000毫克的劑量在效果上有明顯的差異,越高的劑量效果越好.有副作用的病人數目在兩者間沒有顯著的差異,使用paracetamol有19%,使用安慰劑的有16%.

作者結論

Paracetamol是一種安全有效的藥物,用來治療下顎智齒拔除手術後的疼痛.

翻譯人

本摘要由臺灣大學附設醫院張妤欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

paracetamol用於下顎智齒手術拔除後的疼痛緩解.智齒(第三大臼齒)的手術拔除在口腔外科的業務中是最常見的,術後的併發症可能包括腫,瘀青和張口受限,但病人最常注意到的是術後疼痛的問題,有時可能會非常嚴重. Paracetamol能有效緩解疼痛且副作用低,是常用的止痛藥之ㄧ,且不需要處方籤就可以取得.在這篇回顧論文中我們研究出在拔除智齒後給予paracetamol的理想劑量和藥物給予的時間,來達到疼痛緩解的效果,並調查不同劑量的副作用,包含了21個試驗(超過2000位了參與者). Paracetamol和安慰劑在4小時及6小時的疼痛緩解效果相比,明顯有效,最有效的劑量是1000毫克,用藥間隔六小時而不會危害身體.有副作用的病人數目在兩者間沒有顯著的差異,使用paracetamol有19%,使用安慰劑的有16%.需注意的是大部分的研究因缺乏完整的資料報告而受限.然而這篇回顧論文最後推斷paracetamol對於下顎智齒拔除後的疼痛緩解是個安全,有效的藥物.