Combining Paracetamol (Acetaminophen) with Nonsteroidal Antiinflammatory Drugs
Top Cited Papers
- 1 April 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 110 (4), 1170-1179
- https://doi.org/10.1213/ane.0b013e3181cf9281
Abstract
BACKGROUND: There has been a trend over recent years for combining a nonsteroidal antiinflammatory drug (NSAID) with paracetamol (acetaminophen) for pain management. However, therapeutic superiority of the combination of paracetamol and an NSAID over either drug alone remains controversial. We evaluated the efficacy of the combination of paracetamol and an NSAID versus either drug alone in various acute pain models. METHODS: A systematic literature search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PubMed covering the period from January 1988 to June 2009 was performed to identify randomized controlled trials in humans that specifically compared combinations of paracetamol with various NSAIDs versus at least 1 of these constituent drugs. Identified studies were stratified into 2 groups: paracetamol/NSAID combinations versus paracetamol or NSAIDs. We analyzed pain intensity scores and supplemental analgesic requirements as primary outcome measures. In addition, each study was graded for quality using a validated scale. RESULTS: Twenty-one human studies enrolling 1909 patients were analyzed. The NSAIDs used were ibuprofen (n = 6), diclofenac (n = 8), ketoprofen (n = 3), ketorolac (n = 1), aspirin (n = 1), tenoxicam (n = 1), and rofecoxib (n = 1). The combination of paracetamol and NSAID was more effective than paracetamol or NSAID alone in 85% and 64% of relevant studies, respectively. The pain intensity and analgesic supplementation was 35.0% +/- 10.9% and 38.8% +/- 13.1% lesser, respectively, in the positive studies for the combination versus paracetamol group, and 37.7% +/- 26.6% and 31.3% +/- 13.4% lesser, respectively, in the positive studies for the combination versus the NSAID group. No statistical difference in median quality scores was found between experimental groups. CONCLUSION: Current evidence suggests that a combination of paracetamol and an NSAID may offer superior analgesia compared with either drug alonKeywords
This publication has 50 references indexed in Scilit:
- Isobolographic analysis of multimodal analgesia in an animal model of visceral acute painPharmacology Biochemistry and Behavior, 2008
- Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repairAnaesthesia, 2007
- An Evidence-Based Update on Nonsteroidal Anti-Inflammatory DrugsClinical Medicine & Research, 2007
- Combining paracetamol with a selective cyclooxygenase-2 inhibitor for acute pain relief after third molar surgery: a randomized, double-blind, placebo-controlled studyEuropean Journal of Oral Sciences, 2006
- The Analgesic Efficacy of Acetaminophen, Ketoprofen, or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic ProceduresAnesthesia & Analgesia, 2006
- Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomyActa Anaesthesiologica Scandinavica, 2004
- Ibuprofen vs. acetaminophen vs. ibuprofen and acetaminophen after arthroscopically assisted anterior cruciate ligament reconstructionEuropean Journal of Anaesthesiology, 2004
- ADDITIVE EFFECT OF COMBINED NAPROXEN AND PARACETAMOL IN RHEUMATOID ARTHRITISRheumatology, 1993
- Naproxen and paracetamol compared with naproxen only in coxarthrosis: Increased effect of the combination in 18 patientsActa Orthopaedica, 1993
- The efficacy of diclofenac sodium (Voltarol) with and without paracetamol in the control of post-surgical dental painBritish Dental Journal, 1984