Single dose oral analgesics for acute postoperative pain in adults

Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LJ.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 09/2011; 9(9):CD008659. DOI: 10.1002/14651858.CD008659.pub2
Source: PubMed


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of information, and for some adequate information but with results that would have been overturned by just a few unpublished studies with no effect.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.

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    • "Relative efficacy of several analgesics according to the nnt in acute pain [5] [16] [33] (NNT: Number of patients necessary to treat in order to achieve a 50% relief of moderate to severe postoperative pain after a single dose) "
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    ABSTRACT: Just as pain is a symptom with multifarious causes, many approaches can be taken to its management. Once a correct diagnosis has been made, treatment of pain may be chosen from among drug therapy, surgical or other intervention, nerve stimulation, radio waves, physical manipulation, lifestyle changes, psychological and alternative approaches. Thus, medical practitioners involved in assisting patients to manage their pain come from a broad range of fields including clinical psychologists, physiotherapists, occupational therapists, nurses, anesthesiologists, neurologists, physiatrists, psychiatrists and professionals involved in the palliative care of patients. This book seeks to provide a comprehensive overview of the topic of pain management. In so doing, it will act as a resource for students, physicians and other health care professionals, as well as those requiring information in order to better understand their options regarding management of their own pain or that of family members in their care.
    Pain Management, Edited by Gabor Racz, 05/2014: chapter Multimodal Analgesia for the management of postoperative pain: pages 1-42; In Tech Open Access Publisher., ISBN: 980-953-307-1133-0
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    • "The analgesic nefopam (NFP) is one of the drugs for which the mechanism-of-action target is unknown but can be predicted [1]. It was known as fenazocine and developed in the 1960s, and is widely used in European countries as a non-opioid, non-steroidal, centrally acting analgesic drug that belongs to the benzoxazocine chemical class [2,3,4,5]. It has been used most commonly to treat acute postoperative pain; therefore, most studies on NFP were focused on its analgesic potency compared to those of opioids or non-steroidal anti-inflammatory drugs (NSAIDs). "
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    ABSTRACT: Nefopam (NFP) is a non-opioid, non-steroidal, centrally acting analgesic drug that is derivative of the non-sedative benzoxazocine, developed and known in 1960s as fenazocine. Although the mechanisms of analgesic action of NFP are not well understood, they are similar to those of triple neurotransmitter (serotonin, norepinephrine, and dopamine) reuptake inhibitors and anticonvulsants. It has been used mainly as an analgesic drug for nociceptive pain, as well as a treatment for the prevention of postoperative shivering and hiccups. Based on NFP's mechanisms of analgesic action, it is more suitable for the treatment of neuropathic pain. Intravenous administration of NFP should be given in single doses of 20 mg slowly over 15-20 min or with continuous infusion of 60-120 mg/d to minimize adverse effects, such as nausea, cold sweating, dizziness, tachycardia, or drowsiness. The usual dose of oral administration is three to six times per day totaling 90-180 mg. The ceiling effect of its analgesia is uncertain depending on the mechanism of pain relief. In conclusion, the recently discovered dual analgesic mechanisms of action, namely, a) descending pain modulation by triple neurotransmitter reuptake inhibition similar to antidepressants, and b) inhibition of long-term potentiation mediated by NMDA from the inhibition of calcium influx like gabapentinoid anticonvulsants or blockade of voltage-sensitive sodium channels like carbamazepine, enable NFP to be used as a therapeutic agent to treat neuropathic pain.
    The Korean journal of pain 04/2014; 27(2):103-111. DOI:10.3344/kjp.2014.27.2.103
    • "This mode of administration not only could provide appropriate pain relief but also they have some advantages such as easy administration and low cost. In addition some serious side effects of IV form of tramadol have been reported and FDA was not approved the use of tramadol in IV form.[121314] "
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    ABSTRACT: Considering that protocols of postoperative pain management would be planned regarding the facilities of each center or region and the importance of its proper management to reduce its related complication and improve patient's satisfaction, in this study we compared the effect of orally administrated tramadol and acetaminophen-codeine in this regard. In this prospective randomized double-blind clinical trial, 136 (68 in tramadol and 68 in acetaminophen codeine groups) ASA I and II patients scheduled for open cholecystectomy under general anaesthesia were enrolled. They randomly allocated to receive oral tramadol (50 mg capsule) or acetaminophen-codeine (325/10 mg) 1 hour before surgery. After surgery they evaluated for postoperative pain using VAS score, analgesic consumption and vomiting. Mean of postoperative pain score during 24 hours after surgery was 2.1 ± 1.0 and 3.8 ± 2.0 in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). Mean of analgesic consumption (morphine) during 24 hours after surgery was 6.2 ± 4.4 mg and 12.9 ± 5.7 mg in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). Mean of vomiting during 24 hours after surgery was 1.2 ±0.9 and 0.4 ± 0.5 in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). The findings of current study indicated that in lower dose of tramadol (50 mg) and acetaminophen/codeine (325 mg/10 mg) the analgesic effect of tramadol is better and its side effects are higher than acetaminophen/codeine, which limit its use for mentioned purpose. It seems that administration of each of studied agents it depends on patients' tolerance and decision of the physician.
    03/2013; 2(1):12. DOI:10.4103/2277-9175.107964
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