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Paracetamol with and without codeine in acute pain: a quantitative systematic review
A Moore1, S Collins, D Carroll
1Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, The Churchill, Headington, UK. andrew.moore@pru.ox.ac.uk
Pain
|April 1, 1997
Summary
Paracetamol is an effective pain reliever for postoperative pain. Adding codeine significantly enhances its analgesic effect, providing worthwhile additional pain relief even in single doses.
Area of Science:
- Pharmacology
- Clinical Medicine
- Evidence-Based Medicine
Background:
- Postoperative pain management often involves analgesics like paracetamol and codeine.
- The efficacy of single oral doses of paracetamol alone and combined with codeine requires systematic evaluation.
Purpose of the Study:
- To systematically review randomized controlled trials assessing the analgesia from single oral doses of paracetamol and paracetamol plus codeine in postoperative pain.
Main Methods:
- Systematic review of 31 trials (paracetamol vs. placebo), 19 trials (paracetamol + codeine vs. placebo), and 13 trials (paracetamol + codeine vs. paracetamol).
- Extracted pain relief data, converted to dichotomous outcomes (≥50% pain relief).
- Calculated Number-Needed-to-Treat (NNT) for various treatment comparisons.
Main Results:
- Paracetamol 1000 mg alone had an NNT of 3.6; paracetamol 600/650 mg alone had an NNT of 5.0 against placebo.
- Paracetamol 600/650 mg + codeine 60 mg showed a better NNT of 3.1 against placebo.
- Adding 60 mg codeine to paracetamol provided additional pain relief for 12-14% more patients, with an NNT of 9.1.
Conclusions:
- Paracetamol is confirmed as an effective analgesic for postoperative pain.
- The addition of 60 mg codeine to paracetamol provides clinically significant additional pain relief in single oral doses.