ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title For Post-Dental Extraction Pain, Co-therapy with Acetaminophen and Ibuprofen is More Effective in Pain Management than Acetaminophen or Ibuprofen Alone
Clinical Question In patients following a dental extraction is the post-operative administration of combined acetaminophen and ibuprofen better than therapy with acetaminophen or ibuprofen alone for pain management?
Clinical Bottom Line The post-operative use combined acetaminophen and ibuprofen provides superior pain relief compared to acetaminophen or ibuprofen alone.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24338830Bailey/2013Patient Group 2,241 patients ages 16-65 following surgical extraction of mandibular wisdom teeth.Systematic review of randomized trials
Key resultsThree of the seven randomized controlled double-blinded clinical trials included in the review related to the topic. One RCT assessed pain relief, showing a significant increase in the analgesic effects of the combination ibuprofen 400mg/acetaminophen 1000mg compared to the ibuprofen 400mg or acetaminophen 1000mg alone. The 50% pain relief over 6 hours risk ratio was 1.77 (95% CI 1.32-2.39; P value = 0.0002), indicating 77% more patients achieved >50% of maximum pain relief over six hours with the combined drug therapy. Two RCTs assessed the use of rescue medication within 8 hours, where rescue medication is the use of additional pain medication (hydrocodone 7.5mg/acetaminophen 500mg) to manage pain in that time period. Combination therapy with ibuprofen 400mg/acetaminophen 1000mg and ibuprofen 200mg/acetaminophen 500mg where compared to the individual drugs of the same strength. The overall risk ratio was 1.60 (95% CI 1.36-1.88; P value < 0.00001), indicating that 60% more patients used rescue medication within six hours in the individual drug group compared to the combined drug therapy group.
#2) 20007794Merry/2010135 patients over the age of 16 having 1 to 4 wisdom teeth extractedRandomized Controlled Trial
Key resultsCombined therapy with ibuprofen 150mg/acetaminophen 500mg provided superior pain relief after oral surgery to ibuprofen or acetaminophen alone. The primary comparison was made on the basis of the area under the curve (AUC) of the 100mm visual analogue scale pain measurements taken for up to 48 hours post oral surgery, divided by time. The mean time corrected AUC were as follows: Combination ibuprofen 150mg/acetaminophen 500mg 22.3 at rest and 28.4 while active; ibuprofen 150mg 34.8 at rest and 40.2 while active; acetaminophen 500mg 33.0 at rest and 40.4 while active. Results concluded combination ibuprofen 150mg/acetaminophen 500mg therapy having a statistically significant increase in efficacy of pain relief with P<0.01 compared to both ibuprofen 150mg and acetaminophen 500mg alone.
Evidence Search ("tooth extraction"[MeSH Terms] OR ("tooth"[All Fields] AND "extraction"[All Fields]) OR "tooth extraction"[All Fields] OR ("dental"[All Fields] AND "extraction"[All Fields]) OR "dental extraction"[All Fields]) AND ("pain"[MeSH Terms] OR "pain"[All Fields]) AND ("ibuprofen"[MeSH Terms] OR "ibuprofen"[All Fields]) AND ("acetaminophen"[MeSH Terms] OR "acetaminophen"[All Fields])
Comments on
The Evidence
Validity: The systematic review incorporated only randomized controlled trials with double blinding and minimal risk of bias. In the additional randomized controlled trial the patient completion rate was greater than 90% and incorporated adequate procedures of double blinding. Perspective: Measuring a patient's level of pain can prove to be difficult due to the subjective nature of pain and the multiple factors that play into potential post-operative pain. Patient ages and genders, complexity of procedures, and the surgeon doing the procedure should all be addressed and standardized to compare the pain management efficacy.
Applicability For patients in need of post-operative pain management following a dental extraction, combination therapy with ibuprofen and acetaminophen should be readily suggested. Due to widespread availability of both medications and relatively inexpensive price as over the counter medications, the co-therapy should be widely used. Further studies should address the efficacy of the co-therapy with ibuprofen and acetaminophen to other commonly used pain management medications such as hydrocodone and acetaminophen before making a generalized decision.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords extraction, pain management, ibuprofen, acetaminophen
ID# 2734
Date of submission: 06/25/2014spacer
E-mail houaris@livemail.uthscsa.edu
Author Sammy Houari
Co-author(s) Saad Alotaibi and Talal Alrasheed
Co-author(s) e-mail t.t.alrasheed@gmail.com, saadsaud.92@gmail.com
Faculty mentor/Co-author Gregory F. Spackman, DDS, MBA
Faculty mentor/Co-author e-mail spackman@uthscsa.edu
Basic Science Rationale
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