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
. 2013 Oct 23;2013(10):CD007550.
doi: 10.1002/14651858.CD007550.pub3.

Single dose oral dexibuprofen [S(+)-ibuprofen] for acute postoperative pain in adults

Sheena Derry  1 , Jessica Best, R Andrew Moore
Affiliations
Meta-Analysis

Single dose oral dexibuprofen [S(+)-ibuprofen] for acute postoperative pain in adults

Sheena Derry et al. Cochrane Database Syst Rev. .

Abstract

Background: This review is an update of a previously published review in The Cochrane Database of Systematic Reviews Issue 3, 2009 on single dose oral dexibuprofen (S(+)-ibuprofen) for acute postoperative pain in adults.Dexibuprofen is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and widely available in other countries worldwide. It is an active isomer of ibuprofen. This review sought to evaluate the efficacy and safety of oral dexibuprofen in acute postoperative pain, using clinical studies in patients with established pain, and with outcomes measured primarily over four to six hours, using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties.

Objectives: To assess the efficacy and adverse effects of single dose oral dexibuprofen for acute postoperative pain using methods that permit comparison with other analgesics evaluated in standardised studies using almost identical methods and outcomes.

Search methods: Searches were run for the original review in 2009 and subsequent searches have been run in August 2013. We did not find any new published studies as a result of the updated search.We searched for randomised studies of dexibuprofen in acute postoperative pain in MEDLINE, EMBASE, and CENTRAL (The Cochrane LIbrary), and for clinical trial reports and synopses of published and unpublished studies from Internet sources.

Selection criteria: Randomised, double blind, placebo-controlled clinical studies of oral dexibuprofen for relief of acute postoperative pain in adults.

Data collection and analysis: Two review authors independently assessed study quality and extracted data. We extracted pain relief or pain intensity data and converted it into the dichotomous outcome of number of participants with at least 50% pain relief over four to six hours, from which relative risk and number needed to treat to benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. We collected information on adverse events and withdrawals.

Main results: New data were identified for this update in one unpublished trial synopsis (BR1160 1995) in addition to the single study (Dionne 1998) that was included in the original review. In both studies dexibuprofen gave high levels of response, with 51/96 (53%) participants experiencing at least 50% pain relief with dexibuprofen 200 mg and 35/50 (70%) with dexibuprofen 400 mg, compared with 75/147 (51%) with racemic ibuprofen 400 mg, and 12/62 (13%) with placebo. The numbers of participants was too small to calculate NNTs with any meaning. The median time to additional analgesic use was greater than four hours for all active therapies, but about two hours for placebo.Adverse events were generally of mild or moderate intensity and consistent with events normally associated with anaesthesia and surgery. There were no serious adverse events or deaths.Additional data did not alter the conclusions from the earlier review.

Authors' conclusions: The information from these two studies in acute postoperative pain suggested that dexibuprofen may be a useful analgesic, but at doses not very different from racemic ibuprofen, for which considerably more evidence exists.

PubMed Disclaimer

Conflict of interest statement

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

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

BR1160 1995 {unpublished data only}
    1. Lancaster L, Goulder MA. A double blind, singe‐dose, parallel‐group study comparing the analgesic effect of S(+) ibuprofen with racemic ibuprofen and placebo following unilateral or bilateral extraction of third molars. Boots healthcare international, trial synopsis 1995:1‐79.
Dionne 1998 {published data only}
    1. Dionne RA, McCullagh L. Enhanced analgesia and suppression of plasma B‐endorphin by the S(+)‐isomer of ibuprofen. Clinical Pharmacology and Therapeutics 1998;63(5):694‐701. - PubMed

References to studies excluded from this review

Jamali 1999 {published data only}
    1. Jamali F, Kunz‐Dober CM. Pain‐mediated altered absorption and metabolism of ibuprofen: an explanation for decreased serum enantiomer concentration after dental surgery. British Journal of Clinical Pharmacology 1999;47(4):391‐6. - PMC - PubMed

Additional references

Clarke 2012
    1. Clarke R, Derry S, Moore RA. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD004309.pub3] - 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 2009
    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 2010
    1. Derry S, Moore RA, McQuay HJ. Single dose oral codeine, as a single agent, for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 4. [DOI: 10.1002/14651858.CD008099.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. [DOI: 10.1056/NEJM200108093450607] - DOI - PubMed
Gabard 1995
    1. Gabard B, Nirnberger G, Schiel H, Mascher H, Kikuta C, Mayer JM. Comparison of the bioavailability of dexibuprofen administered alone or as part of racemic ibuprofen. European Journal of Clinical Pharmacology 1995;48(6):505‐11. - PubMed
Hawel 2003
    1. Hawel R, Klein G, Singer F, Mayrhofer F, Kahler ST. Comparison of the efficacy and tolerability of dexibuprofen and celecoxib in the treatment of osteoarthritis of the hip. International journal of Clinical Pharmacology and Therapeutics 2003;41(4):153‐64. - PubMed
Higgins 2011
    1. Altman DG, Antes G, Gøtzsche P, Higgins JPT, Jüni P, Lewis S, et al. Assessing risk of bias in included studies. In: Higgins JPT, Altman DG, Sterne JAC editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. www.cochrane‐handbook.org. The Cochrane Collaboration, 2011.
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
Kollenz 2009
    1. Overview on clinical data of dexibuprofen. ADIDAC trial: analgesia with dexibuprofen versus ibuprofen in patients suffering from primary dysmenorrhea: a crossover trial. Gynecologic and Obstetric Investigation 2009;67(1):25‐31. [DOI: 10.1159/000158648] - DOI - PubMed
L'Abbé 1987
    1. L'Abbé KA, Detsky AS, O'Rourke K. Meta‐analysis in clinical research. Annals of Internal Medicine 1987;107:224‐33. - PubMed
Lee 1985
    1. Lee EJ, Williams K, Day R, Graham G, Champion D. Stereoselective disposition of ibuprofen enantiomers in man. British Journal of Clinical Pharmacology 1985;19(5):669‐74. [DOI: 10.1111/j.1365-2125.2004.02288.x] - DOI - PMC - PubMed
McQuay 2005
    1. McQuay HJ, Moore RA. Placebo. Postgraduate Medical Journal 2005;81:155‐60. - PMC - PubMed
McQuay 2012
    1. McQuay HJ, Derry S, Eccleston C, Wiffen PJ, Moore RA. Evidence for analgesic effect in acute pain ‐ 50 years on. Pain 2012;153(7):1364‐7. [DOI: 10.1016/j.pain.2012.01.024] - DOI - PubMed
Moher 1999
    1. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of meta‐analyses of randomised controlled trials: the QUOROM statement. Lancet 1999;354:1896‐900. [DOI: 10.1016/S0140-6736(99)04149-5] - DOI - 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. [DOI: 10.1016/0304-3959(96)03032-1] - DOI - 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. [DOI: 10.1016/S0304-3959(96)03306-4] - DOI - 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. [DOI: 10.1016/S0304-3959(96)03251-4] - DOI - 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. [DOI: 10.1016/S0304-3959(98)00140-7] - DOI - 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. [DOI: 10.1016/j.pain.2005.05.001] - DOI - 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 2011a
    1. Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 9. [DOI: 10.1002/14651858.CD008659.pub2] - DOI - PMC - PubMed
Moore 2013a
    1. Moore A, Derry S, Eccleston C, Kalso E. Expect analgesic failure; pursue analgesic success. BMJ 2013;346:f2690. [DOI: 10.1136/bmj.f2690] - DOI - PubMed
Moore 2013b
    1. Moore RA, Derry S, Straube S, Ireson‐Pain J, Wiffen PJ. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain 2013;epub 14 August. [DOI: 10.1016/j.pain.2013.08.013] - DOI - PubMed
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. London: British Medical Journal, 1995:50‐63. - PMC - PubMed
Nuesch 2010
    1. Nüesch E, Trelle S, Reichenbach S, Rutjes AW, Tschannen B, Altman DG, et al. Small study effects in meta‐analyses of osteoarthritis trials: meta‐epidemiological study. BMJ 2010;341:c3515. [DOI: 10.1136/bmj.c3515] - DOI - PMC - PubMed
PACT 2013
    1. Prescription Cost Analysis, England 2012. London: Health and Social Care Information Centre, 2013. [ISBN: 978‐1‐84‐636859‐2]
Phleps 2001
    1. Phleps W. Overview on clinical data of dexibuprofen. Clinical Rheumatology 2001;20(Suppl 1):S15‐2. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Singer 2000
    1. Singer F, Mayrhofer F, Klein G, Hawel R, Kollenz CJ. Evaluation of the efficacy and dose‐response relationship of dexibuprofen (S(+)‐ibuprofen) in patients with osteoarthritis of the hip and comparison with racemic ibuprofen using the WOMAC osteoarthritis index. International Journal of Clinical Pharmacology and Therapeutics 2000;38(1):15‐24. - 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] - DOI - PMC - PubMed
Zheng 2008
    1. Zheng C, Hao H, Wang G, Sang G, Sun J, Li P, et al. Chiral separation of ibuprofen and chiral pharmacokinetics in healthy Chinese volunteers. European Journal of Drug Metabolism and Pharmacokinetics 2008;33(1):45‐51. - PubMed

References to other published versions of this review

Moore 2009
    1. Moore RA, Derry S, McQuay HJ. Single dose oral dexibuprofen [S(+)‐ibuprofen] for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007550.pub2] - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources