NSAIDs Outperform Codeine for Post-Surgical Pain Control

Dentistry Today


Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen provide better pain control and have fewer adverse effects than codeine, a commonly prescribed opioid, when prescribed after outpatient surgery, according to researchers at McMaster University.

Across all types of surgery, subgroups, and outcome time points, the researchers said, NSAIDs were equal or superior to codeine for postoperative pain.

The researchers said they conducted a systematic review and meta-analysis of 40 high-quality randomized controlled trials (RCTs) involving more than 5,100 adults to compare pain levels and safety of medications with codeine such as Tylenol #3 with NSAIDs.

Patients who took NSAIDs had lower pain scores six and 12 hours after treatment than patients taking codeine.

Patients who were randomized to NSAIDs after outpatient surgical procedures reported better pain scores as well as better global assessment scores and fewer adverse effects, along with a lack of difference in bleeding events, compared to those receiving codeine.

Codeine is widely used for postoperative pain management and is the most commonly prescribed opioid in Canada, the researchers said, but it is associated with a range of adverse effects and potential misuse or addiction.

Alternatives such as NSAIDs can help reduce opioid use in patients after dental and surgical procedures, the researchers said.

Given the range of procedures and dosage combinations included in the high-quality RCTs, the researchers said that their results have wide clinical application.

Furthermore, the researchers said their findings are generally important for any clinician who performs painful medical procedures.

The various trials included in the meta-analysis examined a range of procedures, different NSAID types, and various degrees of acetaminophen administration, the researchers continued.

The researchers concluded that their findings strengthen existing evidence and are broadly generalizable to patients across surgical disciplines.

The study, “Managing Postoperative Pain in Adult Outpatients: A Systematic Review and Meta-Analysis Comparing Codeine with NSAIDs,” was published by the Canadian Medical Association Journal.

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