Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen provide better pain control and have fewer adverse effects than codeine when prescribed after outpatient surgery, according to a study published in the Canadian Medical Association Journal.
“In all surgery types, subgroups, and outcome time-points, NSAIDs were equal or superior to codeine for postoperative pain,” wrote Matthew Choi, MD, McMaster University, Hamilton, Ontario, and colleagues.
The researchers conducted a systematic review and meta-analysis of 40 high-quality randomised controlled trials (RCTs) involving more than 5,100 adults to compare pain levels and safety of medications containing codeine with NSAIDs.
Compared with codeine, NSAIDs were associated with better pain scores at 6 hours (weighted mean difference [WMD], 0.93 points; 95% confidence interval [CI], 0.71-1.15) and at 12 hours (WMD, 0.79; 95% CI, 0.38-1.19). Stronger NSAID superiority at 6 hours was observed among trials where acetaminophen was co-administered at equivalent doses between groups (WMD, 1.18; 95% CI, 0.87-1.48). NSAIDs were also associated with better global assessments at 6 hours and at 24 hours, and were associated with fewer adverse effects, including bleeding events.
“We found that patients randomised to NSAIDs following outpatient surgical procedures reported better pain scores, better global assessment scores, fewer adverse effects, and no difference in bleeding events, compared with those receiving codeine,” the authors wrote.
Given the range of procedures and dosage combinations included in the high-quality RCTs, the authors suggest that their results have wide clinical application.
“These findings are of general importance to any clinician performing painful medical procedures,” the authors wrote. “The various trials in our meta-analysis evaluated a range of procedures, different NSAID types and various degrees of acetaminophen administration. These findings strengthen existing evidence and are broadly generalizable to patients across surgical disciplines.”