Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2011 Feb 16;2011(2):CD007556.
doi: 10.1002/14651858.CD007556.pub2.

Single dose oral fenoprofen for acute postoperative pain in adults

Maria X Traa  1 , Sheena Derry, R Andrew Moore
Affiliations
Meta-Analysis

Single dose oral fenoprofen for acute postoperative pain in adults

Maria X Traa et al. Cochrane Database Syst Rev. .

Abstract

Background: Fenoprofen is a non-steroidal anti-inflammatory drug (NSAID), available in several different countries, but not widely used.

Objectives: To assess the efficacy of single dose oral fenoprofen in acute postoperative pain, and associated adverse events.

Search strategy: We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to December 2010.

Selection criteria: Single oral dose, randomised, double-blind, placebo-controlled trials of fenoprofen for relief of established moderate to severe postoperative pain in adults.

Data collection and analysis: Studies were assessed for methodological quality and data extracted by two review authors independently. Summed total pain relief (TOTPAR) or pain intensity difference (SPID) over 4 to 6 hours was used to calculate the number of participants achieving at least 50% pain relief. These derived results were used to calculate, with 95% confidence intervals, the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over 4 to 6 hours. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected.

Main results: Five studies (696 participants) met the inclusion criteria; 24 participants were treated with fenoprofen 12.5 mg, 23 with fenoprofen 25 mg, 79 with fenoprofen 50 mg, 78 with fenoprofen 100 mg, 146 with fenoprofen 200 mg, 55 with fenoprofen 300 mg, 43 with zomepirac 100 mg, 30 with morphine 8 mg, 77 with codeine 60 mg, and 141 with placebo. Participants had pain following third molar extraction, laparoscopy, minor day surgery and episiotomy. The NNT for at least 50% pain relief over 4 to 6 hours with a single dose of fenoprofen 200 mg compared to placebo was 2.3 (1.9 to 3.0). There were insufficient data to analyse other doses or active comparators, time to use of rescue medication, or numbers of participants needing rescue medication. There was no difference in numbers of participants experiencing any adverse events between fenoprofen 200 mg and placebo. No serious adverse events or adverse event withdrawals were reported in these studies.

Authors' conclusions: Oral fenoprofen 200 mg is effective at treating moderate to severe acute postoperative pain, based on limited data for at least 50% pain relief over 4 to 6 hours. Efficacy of other doses, other efficacy outcomes, and safety and tolerability could not be assessed.

PubMed Disclaimer

Conflict of interest statement

SD and RAM have received research support from charities, government and industry sources at various times, but no such support was received for this work. RAM has consulted for various pharmaceutical companies and received lecture fees from pharmaceutical companies related to analgesics and other healthcare interventions. MXT has no interests to declare.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Forest plot comparing fenoprofen 200 mg versus placebo for the outcome of ≥50% total pain relief over 4 to 6 hours.
3
3
Forest plot comparing fenoprofen 200 mg versus placebo for the outcome of adverse effects over 4 to 6 hours.
1.1
1.1. Analysis
Comparison 1 Fenoprofen 200 mg versus placebo, Outcome 1 Participants with ≥ 50% pain relief over 4 to 6 hours.
1.2
1.2. Analysis
Comparison 1 Fenoprofen 200 mg versus placebo, Outcome 2 Participants with ≥1 adverse effect over 4 to 6 hours.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD007556

References

References to studies included in this review

Cooper 1984 {published data only}
    1. Cooper SA, Gelb S, Goldman E, Cohn P, Dyer C. Comparative efficacy of fenoprofen calcium and zomepirac sodium in postsurgical dental pain. Oral Surgery Oral Medicine Oral Patholology 1984;57(5):485‐9. - PubMed
Davie 1982 {published data only}
    1. Davie IT, Slawson KB, Burt RA. A double‐blind comparison of parenteral morphine, placebo, and oral fenoprofen in management of postoperative pain. Anesthesia and Analgesia 1982;61(12):1002‐5. - PubMed
Laska 1981 {published data only}
    1. Laska EM, Sunshine A. Fenoprofen and codeine analgesia. Clinical Pharmacology and Therapeutics 1981;29(5):606‐16. - PubMed

References to studies excluded from this review

Bettigole 1981 {published data only}
    1. Bettigole JB. A double‐blind comparison of placebo, codeine, and fenoprofen in patients with postpartum pain. Current Therapeutic Research 1981;29(5):778‐84.
Burt 1982 {published data only}
    1. Burt RAP, Davie IT, Slawson KB. A pilot study comparing parenteral morphine, placebo, and oral fenoprofen for the relief of postoperative pain. Current Therapeutic Research 1982;32(2):295‐9.
Davie 1978 {published data only}
    1. Davie IT, Gordon NH. Comparative assessment of fenoprofen and paracetamol given in combination for pain after surgery. British Journal of Anaesthetics 1978;50:931‐5. - PubMed
Derournay 1983 {published data only}
    1. Detournay M. Fenoprofen as a treatment for post‐surgical pain [Le fénoprofène comme traitement des algies postchirurgicales]. Revue Médical de Liège 1983;38:855‐9. - PubMed
Gruber 1976 {published data only}
    1. Gruber CM. Evaluating interactions between fenoprofen and propoxyphene: analgesia and adverse reports by postepisiotomy patients. Journal of Clinical Pharmacology 1976;August‐September:407‐17. - PubMed
Gruber 1979 {published data only}
    1. Gruber CM, Bauer RO. A multicentre study for analgesia involving fenoprofen, propoxyphene (alone or in combination) with placebo and aspirin controls in postpartum pain. Journal of Medicine 1979;10(1‐2):65‐98. - PubMed
Kaiko 1984 {published data only}
    1. Kaiko RF, Wallenstein SL, Lapin J, Houde RW. Oral fenoprofen compared to intramuscular morphine and oral aspirin in cancer patients with postoperative pain. NIDA Research Monograph 1984;49:205‐11. - PubMed
Offen 1985 {published data only}
    1. Offen WW, Gruber CM. Dose response to fenoprofen calcium using placebo and codeine controls. Journal of Medicine 1985;16(4):439‐52. - PubMed
Sechzer 1977 {published data only}
    1. Sechzer PH. Evaluation of fenoprofen as a postoperative analgesic. Current Therapeutic Research 1977;21(2):137‐48. - PubMed
Sunshine 1978 {published data only}
    1. Sunshine A, Slafta J, Gruber C. A comparative analgesic study of propoxyphene, fenoprofen, the combination of propoxyphene and fenoprofen, aspirin, and placebo. Journal of Clinical Pharmacology 1978;November‐December:556‐63. - PubMed

Additional references

Ashraf 1982
    1. Ashraf M, Pearson RM, Winfield DA. Aplastic anaemia associated with fenoprofen. BMJ (Clin Res Ed) 1982;284(6325):1301‐2. - PMC - PubMed
Barden 2004
    1. Barden J, Edwards JE, McQuay HJ, Wiffen PJ. Relative efficacy of oral analgesics after third molar extraction. British Dental Journal 2004;197(7):407‐11. - PubMed
Brogden 1978
    1. Brogden RN, Heel RC, Speight TM, Avery GS. Fenbufen: a review of its pharmacological properties and therapeutic use in rheumatic diseases and acute pain. Drugs 1981;21(1):1‐22. - PubMed
Clarke 2009
    1. Clarke R, Derry S, Moore RA, McQuay HJ. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004309.pub2] - DOI - PubMed
Collins 1997
    1. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres?. Pain 1997;72:95‐7. - PubMed
Collins 2001
    1. Collins SL, Edwards J, Moore RA, Smith LA, McQuay HJ. Seeking a simple measure of analgesia for mega‐trials: is a single global assessment good enough?. Pain 2001;91(1‐2):189‐94. - PubMed
Cook 1995
    1. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310(6977):452‐4. - PMC - PubMed
Cooper 1991
    1. Cooper SA. Single‐dose analgesic studies: the upside and downside of assay sensitivity. The Design of Analgesic Clinical Trials. Advances in Pain Research Therapy 1991;18:117‐24.
Derry 2008
    1. Derry S, Moore RA, McQuay HJ. Single dose oral celecoxib for acute postoperative pain. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD004233] - DOI - PubMed
Derry C 2009a
    1. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD001548.pub2] - DOI - PMC - PubMed
Derry C 2009b
    1. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral naproxen and naproxen sodium for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD004234.pub2] - DOI - PMC - PubMed
Derry P 2009
    1. Derry P, Derry S, Moore RA, McQuay HJ. Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD004768.pub2] - DOI - PMC - PubMed
Fitzgerald 2001
    1. FitzGerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase‐2. New England Journal of Medicine 2001;345(6):433‐42. - PubMed
Hawkey 1999
    1. Hawkey CJ. Cox‐2 inhibitors. Lancet 199;353(9149):307‐14. - PubMed
Jadad 1996a
    1. Jadad AR, Carroll D, Moore RA, McQuay H. Developing a database of published reports of randomised clinical trials in pain research. Pain 1996;66(2‐3):239‐46. - PubMed
Jadad 1996b
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
Katz 1980
    1. Katz ME, Wang P. Fenoprofen‐associated thrombocytopenia. Annals of Internal Medicine 1980;92(2 Pt 1):262. - PubMed
L'Abbe 1987
    1. L'Abbé KA, Detsky AS, O'Rourke K. Meta‐analysis in clinical research. Annals of Internal Medicine 1987;107:224‐33. - PubMed
Lloyd 2009
    1. Lloyd R, Derry S, Moore RA, McQuay HJ. Intravenous parecoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004771.pub4] - DOI - PMC - PubMed
McQuay 2005
    1. McQuay HJ, Moore RA. Placebo. Postgraduate Medical Journal 2005;81:155‐60. - PMC - PubMed
Moore 1996
    1. Moore A, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics. Pain 1996;66(2‐3):229‐37. - PubMed
Moore 1997a
    1. Moore A, Moore O, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics: use of pain intensity and visual analogue scales. Pain 1997;69(3):311‐5. - PubMed
Moore 1997b
    1. Moore A, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics: verification from independent data. Pain 1997;69(1‐2):127‐30. - PubMed
Moore 1998
    1. Moore RA, Gavaghan D, Tramer MR, Collins SL, McQuay HJ. Size is everything‐large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998;78(3):209‐16. - PubMed
Moore 2003
    1. Moore RA, Edwards J, Barden J, McQuay HJ. Bandolier's Little Book of Pain. Oxford: Oxford University Press, 2003. [ISBN: 0‐19‐263247‐7]
Moore 2005
    1. Moore RA, Edwards JE, McQuay HJ. Acute pain: individual patient meta‐analysis shows the impact of different ways of analysing and presenting results. Pain 2005;116(3):322‐31. - PubMed
Moore 2006
    1. Moore A, McQuay H. Bandolier's Little Book of Making Sense of the Medical Evidence. Oxford: Oxford University Press, 2006. [ISBN: 0‐19‐856604‐2]
Moore 2008
    1. Moore RA, Barden J, Derry S, McQuay HJ. Managing potential publication bias. In: McQuay HJ, Kalso E, Moore RA editor(s). Systematic Reviews in Pain Research: Methodology Refined. Seattle: IASP Press, 2008:15‐24. [ISBN: 978‐0‐931092‐69‐5]
Morris 1995
    1. Morris JA, Gardner MJ. Calculating confidence intervals for relative risk, odds ratio and standardised ratios and rates. In: Gardner MJ, Altman DG editor(s). Statistics with Confidence ‐ Confidence Intervals and Statistical Guidelines. British Medical Journal, 1995:50‐63. - PMC - PubMed
PACT 2010
    1. The NHS Information Centre, Prescribing Support Unit. Prescription cost analysis, England 2009. 2010. [ISBN: 978‐1‐84636‐408‐2]
Roy 2010
    1. Roy YM, Derry S, Moore RA. Single dose oral lumiracoxib for postoperative pain. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD006865.pub2] - DOI - PMC - PubMed
Simon 1978
    1. Simon SD, Kosmin M. Fenoprofen and agranulocytosis. New England Journal of Medicine 1978;299(9):490(299):490. - PubMed
Simpson 1978
    1. Simpson RE 3rd, Goldstein DJ, Hjelte GS, Evans ER. Acute thrombocytopenia associated with fenoprofen. New England Journal of Medicine 1978;298(11):629‐30. - PubMed
Toms 2008
    1. Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD004602.pub2] - DOI - PMC - PubMed
Tramer 1997
    1. Tramèr MR, Reynolds DJM, Moore RA, McQuay HJ. Impact of covert duplicate results on meta‐analysis: a case study. BMJ 1997;315:635‐9. - PMC - PubMed

MeSH terms

LinkOut - more resources