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Meta-Analysis
. 2008 Oct 8;2008(4):CD004602.
doi: 10.1002/14651858.CD004602.pub2.

Single dose oral paracetamol (acetaminophen) for postoperative pain in adults

Laurence Toms  1 , Henry J McQuay, Sheena Derry, R Andrew Moore
Affiliations
Meta-Analysis

Single dose oral paracetamol (acetaminophen) for postoperative pain in adults

Laurence Toms et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an updated version of the original Cochrane review published in Issue 1, 2004 - this original review had been split from a previous title on 'Single dose paracetamol (acetaminophen) with and without codeine for postoperative pain'. The last version of this review concluded that paracetamol is an effective analgesic for postoperative pain, but additional trials have since been published. This review sought to evaluate the efficacy and safety of paracetamol using current data, and to compare the findings with other analgesics evaluated in the same way.

Objectives: To assess the efficacy of single dose oral paracetamol for the treatment of acute postoperative pain.

Search strategy: We searched The Cochrane Library, MEDLINE, EMBASE, the Oxford Pain Relief Database and reference lists of articles to update an existing version of the review in July 2008.

Selection criteria: Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. Area under the "pain relief versus time" curve was used to derive the proportion of participants with paracetamol or placebo experiencing at least 50% pain relief over four to six hours, using validated equations. Number-needed-to-treat-to-benefit (NNT) was calculated, with 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use, were sought as measures of duration of analgesia. Information on adverse events and withdrawals was also collected.

Main results: Fifty-one studies, with 5762 participants, were included: 3277 participants were treated with a single oral dose of paracetamol and 2425 with placebo. About half of participants treated with paracetamol at standard doses achieved at least 50% pain relief over four to six hours, compared with about 20% treated with placebo. NNTs for at least 50% pain relief over four to six hours following a single dose of paracetamol were as follows: 500 mg NNT 3.5 (2.7 to 4.8); 600 to 650 mg NNT 4.6 (3.9 to 5.5); 975 to 1000 mg NNT 3.6 (3.4 to 4.0). There was no dose response. Sensitivity analysis showed no significant effect of trial size or quality on this outcome.About half of participants needed additional analgesia over four to six hours, compared with about 70% with placebo. Five people would need to be treated with 1000 mg paracetamol, the most commonly used dose, to prevent one needing rescue medication over four to six hours, who would have needed it with placebo. Adverse event reporting was inconsistent and often incomplete. Reported adverse events were mainly mild and transient, and occurred at similar rates with 1000 mg paracetamol and placebo. No serious adverse events were reported. Withdrawals due to adverse events were uncommon and occurred in both paracetamol and placebo treatment arms.

Authors' conclusions: A single dose of paracetamol provides effective analgesia for about half of patients with acute postoperative pain, for a period of about four hours, and is associated with few, mainly mild, adverse events.

PubMed Disclaimer

Conflict of interest statement

RAM & HJM have consulted for various pharmaceutical companies. RAM & HJM have received lecture fees from pharmaceutical companies that market analgesics and other healthcare interventions. RAM, HJM and SD have received research support from charities, government and industry sources at various times, but no such support was received for this work.

Figures

1
1
Forest plot of comparison: 3 Paracetamol 500 mg versus placebo, outcome: 3.1 Participants with at least 50% pain relief over 4 to 6 hours.
2
2
Forest plot of comparison: 4 Paracetamol 600‐650 mg versus placebo, outcome: 4.1 Participants with at least 50% pain relief over 4 to 6 hours.
3
3
Forest plot of comparison: 5 Paracetamol 975‐1000 mg versus placebo, outcome: 5.1 Participants with at least 50% pain relief over 4 to 6 hours.
4
4
Forest plot of comparison: 3 Paracetamol 500 mg versus placebo, outcome: 3.4 Participants using rescue medication over 4 to 6 hours.
5
5
Forest plot of comparison: 4 Paracetamol 600‐650 mg versus placebo, outcome: 4.4 Participants using rescue medication over 4 to 6 hours.
6
6
Forest plot of comparison: 5 Paracetamol 975‐1000 mg versus placebo, outcome: 5.4 Participants using rescue medication over 4 to 6 hours.
7
7
Forest plot of comparison: 1 Paracetamol all doses versus placebo, outcome: 1.3 Participants with any adverse event.
8
8
Forest plot of comparison: 3 Paracetamol 500 mg versus placebo, outcome: 3.5 Participants with any adverse event.
9
9
Forest plot of comparison: 4 Paracetamol 600‐650 mg versus placebo, outcome: 4.5 Participants with any adverse event.
10
10
Forest plot of comparison: 5 Paracetamol 975‐1000 mg versus placebo, outcome: 5.5 Participants with any adverse event.
1.1
1.1. Analysis
Comparison 1 Paracetamol all doses versus placebo, Outcome 1 Participants with at least 50% pain relief over 4 to 6 hours.
1.2
1.2. Analysis
Comparison 1 Paracetamol all doses versus placebo, Outcome 2 Participants using rescue medication over 4 to 6 hours.
1.3
1.3. Analysis
Comparison 1 Paracetamol all doses versus placebo, Outcome 3 Participants with any adverse event.
1.4
1.4. Analysis
Comparison 1 Paracetamol all doses versus placebo, Outcome 4 Participants with any adverse event, dental.
1.5
1.5. Analysis
Comparison 1 Paracetamol all doses versus placebo, Outcome 5 Participants with any adverse event, surgical.
2.1
2.1. Analysis
Comparison 2 Paracetamol 325 mg versus placebo, Outcome 1 Participants with at least 50% pain relief over 4 to 6 hours.
3.1
3.1. Analysis
Comparison 3 Paracetamol 500 mg versus placebo, Outcome 1 Participants with at least 50% pain relief over 4 to 6 hours.
3.2
3.2. Analysis
Comparison 3 Paracetamol 500 mg versus placebo, Outcome 2 Participants with at least 50% pain relief over 4 to 6 hours, dental.
3.3
3.3. Analysis
Comparison 3 Paracetamol 500 mg versus placebo, Outcome 3 Participants with at least 50% pain relief over 4 to 6 hours, surgical.
3.4
3.4. Analysis
Comparison 3 Paracetamol 500 mg versus placebo, Outcome 4 Participants using rescue medication over 4 to 6 hours.
3.5
3.5. Analysis
Comparison 3 Paracetamol 500 mg versus placebo, Outcome 5 Participants with any adverse event.
4.1
4.1. Analysis
Comparison 4 Paracetamol 600‐650 mg versus placebo, Outcome 1 Participants with at least 50% pain relief over 4 to 6 hours.
4.2
4.2. Analysis
Comparison 4 Paracetamol 600‐650 mg versus placebo, Outcome 2 Participants with at least 50% pain relief over 4 to 6 hours, dental.
4.3
4.3. Analysis
Comparison 4 Paracetamol 600‐650 mg versus placebo, Outcome 3 Participants with at least 50% pain relief over 4 to 6 hours, surgical.
4.4
4.4. Analysis
Comparison 4 Paracetamol 600‐650 mg versus placebo, Outcome 4 Participants using rescue medication over 4 to 6 hours.
4.5
4.5. Analysis
Comparison 4 Paracetamol 600‐650 mg versus placebo, Outcome 5 Participants with any adverse event.
5.1
5.1. Analysis
Comparison 5 Paracetamol 975‐1000 mg versus placebo, Outcome 1 Participants with at least 50% pain relief over 4 to 6 hours.
5.2
5.2. Analysis
Comparison 5 Paracetamol 975‐1000 mg versus placebo, Outcome 2 Participants with at least 50% pain relief over 4 to 6 hours, dental.
5.3
5.3. Analysis
Comparison 5 Paracetamol 975‐1000 mg versus placebo, Outcome 3 Participants with at least 50% pain relief over 4 to 6 hours, surgical.
5.4
5.4. Analysis
Comparison 5 Paracetamol 975‐1000 mg versus placebo, Outcome 4 Participants using rescue medication over 4 to 6 hours.
5.5
5.5. Analysis
Comparison 5 Paracetamol 975‐1000 mg versus placebo, Outcome 5 Participants with any adverse event.
6.1
6.1. Analysis
Comparison 6 Paracetamol 1500 mg versus placebo, Outcome 1 Participants with at least 50% pain relief over 4 to 6 hours.
7.1
7.1. Analysis
Comparison 7 Paracetamol versus placebo, sensitivity analysis, Outcome 1 Quality score of 3 or more.
7.2
7.2. Analysis
Comparison 7 Paracetamol versus placebo, sensitivity analysis, Outcome 2 Quality of 2.
7.3
7.3. Analysis
Comparison 7 Paracetamol versus placebo, sensitivity analysis, Outcome 3 More than 40 patients in each arm, 975/1000mg paracetamol vs placebo, quality score of three of more, dental.
7.4
7.4. Analysis
Comparison 7 Paracetamol versus placebo, sensitivity analysis, Outcome 4 Less than 40 patients in each arm, 975/1000mg paracetamol vs placebo, quality score of three of more, dental.
See this image and copyright information in PMC

Update of

References

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References to studies excluded from this review

Becker 1990 {published data only}
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References to other published versions of this review

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