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. 2015 Oct 13;2015(10):CD011407.
doi: 10.1002/14651858.CD011407.pub2.

Adverse events associated with single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews

R Andrew Moore  1 , Sheena Derry, Dominic Aldington, Philip J Wiffen
Affiliations

Adverse events associated with single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews

R Andrew Moore et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an update of a Cochrane overview published in Issue 9, 2011; that overview considered both efficacy and adverse events. This overview considers adverse events, with efficacy dealt with in a separate overview.Thirty-nine Cochrane reviews of randomised trials have examined the adverse events associated with individual drug interventions in acute postoperative pain. This overview brings together the results of those individual reviews.

Objectives: To provide an overview of adverse event rates associated with single-dose oral analgesics, compared with placebo, for acute postoperative pain in adults.

Methods: We identified systematic reviews in The Cochrane Database of Systematic Reviews on The Cochrane Library through a simple search strategy. All reviews were overseen by a single review group. We extracted information related to participants experiencing any adverse event, and reports of serious adverse events, and deaths from the individual reviews.

Main results: Information was available from 39 Cochrane reviews for 41 different analgesics or analgesic combinations (51 drug/dose/formulations) tested in single oral doses in participants with moderate or severe postoperative pain. This involved around 350 unique studies involving about 35,000 participants. Most studies involved younger participants with pain following removal of molar teeth.For most nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and combinations not containing opioids, there were few examples where participants experienced significantly more or fewer adverse events than with placebo. For aspirin 1000 mg and diflunisal 1000 mg, opioids, or fixed-dose combination drugs containing opioids, participants typically experienced significantly more adverse events than with placebo. Studies of combinations of ibuprofen and paracetamol reported significantly fewer adverse events.Serious adverse events were rare, occurring a rate of about 1 in 3200 participants.Most reviews did not report specific adverse events.

Authors' conclusions: Despite ongoing problems with the measurement, recording, and reporting of adverse events in clinical trials and in systematic reviews, the large amount of information available for single oral doses of analgesics provides evidence that adverse events rates are generally similar with active drug and placebo in these circumstances, except at higher doses of some drugs, and in combinations including opioids.

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Conflict of interest statement

SD has no declarations of interest relevant to this review.

PJW has no declarations of interest relevant to this review.

RAM has no declarations of interest relevant to this review.

DA has no declarations of interest relevant to this review.

We are funded by the NIHR for work on a series of reviews informing the unmet need of chronic pain and providing the evidence for treatments of pain but this review is not supported by that funding.

This review was identified in a 2019 audit as not meeting the current definition of the Cochrane Commercial Sponsorship policy. At the time of its publication it was compliant with the interpretation of the existing policy. As with all reviews, new and updated, at update this review will be revised according to 2020 policy update.

Comment in

References

References to included reviews

Aceclofenac 2009
    1. Moore RA, Derry S, McQuay HJ. Single dose oral aceclofenac for postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007588.pub2] - DOI - PMC - PubMed
Acemetacin 2009
    1. Moore RA, Derry S, McQuay HJ. Single dose oral acemetacin for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007589.pub2] - DOI - PMC - PubMed
Aspirin 2012
    1. Derry S, Moore RA. Single dose oral aspirin for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD002067.pub2] - DOI - PMC - PubMed
Celecoxib 2013
    1. Derry S, Moore RA. Single dose oral celecoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2013, Issue 10. [DOI: 10.1002/14651858.CD004233.pub4] - DOI - PMC - PubMed
Codeine 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
Dexibuprofen 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
Diclofenac 2015
    1. Moore RA, Derry S, Wiffen PJ. Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 7. [DOI: 10.1002/14651858.CD004768.pub3] - DOI - PMC - PubMed
Diflunisal 2010
    1. Wasey JO, Derry S, Moore RA, McQuay HJ. Single dose oral diflunisal for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 4. [DOI: 10.1002/14651858.CD007440.pub2] - DOI - PMC - PubMed
Dihydrocodeine 2000
    1. Moore RA, Rees J, Derry S, McQuay HJ. Single dose oral dihydrocodeine for acute postoperative pain. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD002760] - DOI - PMC - PubMed
Dipyrone 2010
    1. Edwards J, Meseguer F, Faura C, Moore RA, McQuay HJ, Derry S. Single dose dipyrone for acute postoperative pain. Cochrane Database of Systematic Reviews 2010, Issue 9. [DOI: 10.1002/14651858.CD003227.pub2] - DOI - PMC - PubMed
Etodolac 2009
    1. Tirunagari SK, Derry S, Moore RA, McQuay HJ. Single dose oral etodolac for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007357.pub2] - DOI - PMC - PubMed
Etoricoxib 2014
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Fenbufen 2009
    1. Moore RA, Derry S, McQuay HJ. Single dose oral fenbufen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007547.pub2] - DOI - PMC - PubMed
Fenoprofen 2011
    1. Traa MX, Derry S, Moore RA. Single dose oral fenoprofen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 2. [DOI: 10.1002/14651858.CD007556.pub2] - DOI - PMC - PubMed
Flurbiprofen 2009
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Gabapentin 2010
    1. Straube S, Derry S, Moore RA, Wiffen PJ, McQuay HJ. Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 5. [DOI: 10.1002/14651858.CD008183.pub2] - DOI - PMC - PubMed
Ibuprofen + caffeine 2015
    1. Derry S, Wiffen PJ, Moore RA. Single dose oral ibuprofen plus caffeine for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 7. [DOI: 10.1002/14651858.CD011509.pub2] - DOI - PMC - PubMed
Ibuprofen + codeine 2015
    1. Derry S, Karlin S, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 2. [DOI: 10.1002/14651858.CD010107.pub3] - DOI - PMC - PubMed
Ibuprofen + oxycodone 2013
    1. Derry S, Derry CJ, Moore RA. Single dose oral ibuprofen plus oxycodone for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010289.pub2] - DOI - PMC - PubMed
Ibuprofen + paracetamol 2013
    1. Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010210.pub2] - DOI - PMC - PubMed
Ibuprofen 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
Indometacin 2004
    1. Moore RA, Derry S, Mason L, McQuay HJ, Rees J. Single dose oral indometacin for the treatment of acute postoperative pain. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD004308.pub2] - DOI - PMC - PubMed
Ketoprofen and dexketoprofen 2009
    1. Barden J, Derry S, McQuay HJ, Moore RA. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007355.pub2] - DOI - PMC - PubMed
Lornoxicam 2009
    1. Hall PE, Derry S, Moore RA, McQuay HJ. Single dose oral lornoxicam for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007441.pub2] - DOI - PMC - PubMed
Lumiracoxib 2010
    1. Roy YM, Derry S, Moore RA. Single dose oral lumiracoxib for postoperative pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD006865.pub2] - DOI - PMC - PubMed
Mefenamic acid 2011
    1. Moll R, Derry S, Moore RA, McQuay HJ. Single dose oral mefenamic acid for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD007553.pub2] - DOI - PMC - PubMed
Meloxicam 2009
    1. Moore RA, Derry S, McQuay HJ. Single dose oral meloxicam for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007552.pub2] - DOI - PMC - PubMed
Nabumetone 2009
    1. Moore RA, Derry S, Moore M, McQuay HJ. Single dose oral nabumetone for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007548.pub2] - DOI - PMC - PubMed
Naproxen 2009
    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.pub3] - DOI - PMC - PubMed
Nefopam 2009
    1. Kakkar M, Derry S, Moore RA, McQuay HJ. Single dose oral nefopam for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007442.pub2] - DOI - PMC - PubMed
Paracetamol + codeine 2009
    1. Toms L, Derry S, Moore RA, McQuay HJ. Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD001547.pub2] - DOI - PMC - PubMed
Paracetamol 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
Paracetamol ± dextropropoxyphene 1999
    1. Moore RA, Collins S, Rees J, Derry S, McQuay HJ. Single dose oral dextropropoxyphene, alone and with paracetamol (acetaminophen), for postoperative pain. Cochrane Database of Systematic Reviews 1999, Issue 1. [DOI: 10.1002/14651858.CD001440] - DOI - PMC - PubMed
Paracetamol ± oxycodone 2009
    1. Gaskell H, Derry S, Moore RA, McQuay HJ. Single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD002763.pub2] - DOI - PMC - PubMed
Piroxicam 2000
    1. Moore RA, Rees J, Loke Y, Derry S, McQuay HJ. Single dose oral piroxicam for acute postoperative pain. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD002762] - DOI - PMC - PubMed
Rofecoxib 2009
    1. Bulley S, Derry S, Moore RA, McQuay HJ. Single dose oral rofecoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD004604.pub3] - DOI - PMC - PubMed
Sulindac 2009
    1. Moore RA, Derry S, McQuay HJ. Single dose oral sulindac for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007540.pub2] - DOI - PMC - PubMed
Tenoxicam 2009
    1. Moore OA, McIntyre M, Moore RA, Derry S, McQuay HJ. Single dose oral tenoxicam for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007591.pub2] - DOI - PMC - PubMed
Tiaprofenic acid 2009
    1. Moore RA, Derry S, Moore M, McQuay HJ. Single dose oral tiaprofenic acid for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007542.pub2] - DOI - PMC - PubMed

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