Single dose oral mefenamic acid for acute postoperative pain in adults

Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LJ.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 03/2011; DOI: 10.1002/14651858.CD007553.pub2
Source: PubMed


Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) that is used as a painkiller (analgesic). Four studies involving a total of 842 participants were included in this review. Because fewer than 200 participants were treated with mefenamic acid within these four studies, results must be treated with caution. A good level of pain relief is experienced by almost half (48%) of those with moderate to severe postoperative pain after a single dose of mefenamic acid 500 mg, compared to about 20% with placebo, and fewer will need additional analgesia within 6 hours (47% versus 62%). This level of pain relief is comparable to that experienced with paracetamol 1000 mg. Adverse events could not be assessed in these studies.

Download full-text


Available from: Henry Mcquay,
230 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: All analgesic drugs (painkillers) are tested in standardised clinical studies of people with established pain following surgery, and often after removal of third molar (wisdom) teeth. In all these studies the participants have to have at least moderate pain in order for there to be a sensitive measure of pain-relieving properties. The Cochrane Library has 35 reviews of oral analgesic interventions, with 38 different drugs, at various doses involving 45,000 participants in about 350 studies. This overview sought to bring all this information together, and to report the results for those drugs with reliable evidence about how well they work or any harm they may do in single oral doses. For some drugs there were no published trials, for some inadequate amounts of information, and for some adequate information but with results that would have been overturned by just a few unpublished studies with no effect. None of these could be regarded as reliable. However, amongst the data there were still 46 drug/dose combinations with reliable evidence. No drug produced high levels of pain relief in all participants. The range of results with single-dose analgesics in participants with moderate or severe acute pain was from 70% achieving good pain relief with the best drug to about 30% with the worst drug. The period over which pain was relieved also varied, from about two hours to about 20 hours. Typically adverse event rates were no higher with analgesic drugs than with placebo, except often with opioids (for example, codeine, oxycodone) where more participants experienced them. Commonly used analgesic drugs at the recommended or licensed doses produce good pain relief in some, but not all, patients with pain. The reasons for this are varied, but patients in pain should not be surprised if drugs they are given do not work for them. Alternatives analgesic drugs or procedures should be found that do work.
    Cochrane database of systematic reviews (Online) 09/2011; 9(9):CD008659. DOI:10.1002/14651858.CD008659.pub2 · 6.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The medical impact of pain has triggered efforts of drug development directed toward new analgesic targets or repurposing of known drugs for use in pain therapy. Ongoing research requires cost-saving instruments to translate basic science knowledge into clinically effective analgesic compounds. This review re-examined the prediction of clinical analgesia by human experimental pain models as a basis for model selection in phase I studies. The overall prediction of analgesic efficacy or failure of a drug correlated well between experimental and clinical settings. However, correct model selection requires more detailed information about which model predicts which clinical pain condition. We hypothesized that if an analgesic drug was effective in an experimental pain model and also in a clinical pain setting, then the model might be predictive for the particular clinical setting and should be selected in drug development of analgesics targeted at the particular clinical pain condition. The validity of the prediction increases with increasing numbers of analgesic drug classes for which this agreement was shown. From available evidence only five clinical pain conditions were correctly predicted by seven different pain models for at least three different drugs. Most of these models combine a sensitization method. The analysis also identified several models with low impact with respect to the clinical translation. Thus, the presently identified agreements and non-agreements between analgesic effects on experimental and on clinical pain may serve as a solid basis to identify complex sets of human pain models that bridge basic science with clinical pain research.
    British Journal of Pharmacology 10/2012; 168(3). DOI:10.1111/bph.12023 · 4.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question "which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?". Materials and methods: A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review. Results: Fourteen studies with 3521 subjects, with 10 groups (17 dosages) of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6) and total pain relief at 6 hours (TOTPAR6). The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 - 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31). Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects. Conclusion: This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study.
    PLoS ONE 06/2015; 10(6):e0127611. DOI:10.1371/journal.pone.0127611 · 3.23 Impact Factor
Show more