How do over‐the‐counter analgesics compare in adults with acute postoperative pain?

Abstract

In adults, ibuprofen 400 mg plus paracetamol 1000 mg seems to effectively reduce pain after surgery without a concomitant increase in adverse events; reviewers rated the evidence as good quality.Reviewers conducted an overview of Cochrane Reviews that assessed the impact of analgesics available over the counter in the UK on acute postoperative pain in adults. Researchers compared each analgesic with placebo and calculated the number needed to treat for one additional person to have a beneficial outcome (NNTB). In terms of achieving at least 50% pain relief, aspirin 500 mg was no better than placebo. Of the other analgesics assessed, the lowest NNTB was for ibuprofen 400 mg plus paracetamol 1000 mg (NNTB 1.5; all values on average); the remaining analgesics had NNTBs from 1.6 (ibuprofen 200 mg plus paracetamol 500 mg) to 4.6 (paracetamol 600/650 mg). Success of pain relief ranged from 11% (with aspirin 500 mg) to 70% (with 400 mg ibuprofen plus 1000 mg paracetamol). Three analgesics showed higher rates of adverse events versus placebo (aspirin 600/650 mg and 1000 mg and ibuprofen 200 mg plus caffeine 100 mg), and two analgesics showed lower rates of adverse events (ibuprofen 200 or 400 mg plus paracetamol 500 or 1000 mg, respectively).