Single dose oral ibuprofen plus caffeine for acute postoperative pain in adults
Derry S, Wiffen PJ, Moore RA
The Cochrane database of systematic reviews · 19 citations
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Institute for Health and Care Research
- Government
- National Institutes of Health
Based on 2 listed funder(s).
Publication
- Published
- 2015-07-14 · Cochrane Database Syst Rev · vol. 2019 · issue 5 · p. CD011509
- Publisher
- Elsevier BV
- Cited
- 87 citations · more than 100% of similar papers · 25.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 103 works
- Access
- Free to read
- Research areas
- Pediatric Pain Management Techniques · Anesthesia and Pain Management · Migraine and Headache Studies
- Keywords
- Ibuprofen, Caffeine, Medicine, Anesthesia, Acute pain, Pharmacology, Internal medicine
- MeSH
- humans, ibuprofen, caffeine, analgesics, non-narcotic, drug combinations, adult, randomized controlled trials as topic, numbers needed to treat, acute pain, postoperative pain
3 authors
From GB
- Sheena DerryChurchill Hospital
- Philip J WiffenThame Community Hospital
- R Andrew MooreUniversity of Oxford
Abstract
Background
There is good evidence that combining two different analgesics in fixed doses in a single tablet can provide better pain relief in acute pain and headache than either drug alone, and that the drug-specific benefits are essentially additive. This appears to be broadly true in postoperative pain and migraine headache across a range of different drug combinations, and when tested in the same and different trials. Adding caffeine to analgesics also increases the number of people obtaining good pain relief. Combinations of ibuprofen and caffeine are available without prescription in some parts of the world.
Objectives
To assess the analgesic efficacy and adverse effects of a single oral dose of ibuprofen plus caffeine for moderate to severe postoperative pain, using methods that permit comparison with other analgesics evaluated in standardised trials using almost identical methods and outcomes.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Relief Database, two clinical trial registries, and the reference lists of articles. The date of the most recent search was 1 February 2015.
Selection criteria
Randomised, double-blind, placebo- or active-controlled clinical trials of single dose oral ibuprofen plus caffeine for acute postoperative pain in adults.
Data collection and analysis
Two review authors independently considered trials for inclusion in the review, assessed risk of bias, and extracted data. We used the area under the pain relief versus time curve to derive the proportion of participants with at least 50% pain relief over six hours prescribed either ibuprofen plus caffeine or placebo. We calculated the risk ratio (RR) and number needed to treat to benefit (NNT). We used information on the use of rescue medication to calculate the proportion of participants requiring rescue medication and the weighted mean of the median time to use. We also collected information on adverse effects.
Main results
We identified five randomised, double-blind studies with 1501 participants, but only four had been published and had relevant outcome data. These four studies were of high quality, although two of the studies were small.Both ibuprofen 200 mg + caffeine 100 mg and ibuprofen 100 mg + caffeine 100 mg produced significantly more participants than placebo who achieved at least 50% of maximum pain relief over six hours, and both doses significantly reduced remedication rates (moderate quality evidence). For at least 50% of maximum pain relief, the NNT was 2.1 (95% confidence interval 1.8 to 2.5) for ibuprofen 200 mg + caffeine 100 mg (four studies, 334 participants) and 2.4 (1.9 to 3.1) for ibuprofen 100 mg + caffeine 100 mg (two studies, 200 participants) (moderate quality evidence). These values were close to those predicted by published models for combination analgesics in acute pain, and were supported by low (good) NNT values for prevention of remedication.Adverse event rates were low, and no sensible analysis was possible.
Authors' conclusions
For ibuprofen 200 mg + caffeine 100 mg particularly, the low NNT value is among the lowest (best) values for analgesics in this pain model. The combination is not commonly available, but can be probably be achieved by taking a single 200 mg ibuprofen tablet with a cup of modestly strong coffee or caffeine tablets. In principle, this can deliver good analgesia at lower doses of ibuprofen.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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