Evaluating Analgesic Benefits of NSAID Combinations for Acute Postoperative Dental Pain

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Pain relief efficacy was defined as ≥50% relief from maximum pain for a duration of 4 to 6 hours.
Pain relief efficacy was defined as ≥50% relief from maximum pain for a duration of 4 to 6 hours.

Acetaminophen in combination with ibuprofen or oxycodone, as well as diclofenac, and flurbiprofen may offer more effective analgesia for acute postoperative dental pain in adults than other drug combinations, according to a study published in the Journal of the American Dental Association.

This study consisted of an overview of 5 systematic reviews that assessed safety and efficacy of several pharmacologic options for acute postoperative dental pain (eg, after third-molar extraction). Management strategies included oral opioid and nonopioid analgesic medications.

Pain relief efficacy was defined as ≥50% relief from maximum pain for a duration of 4 to 6 hours. In addition, investigators evaluated data on pain relief duration and acute adverse events associated with treatment.

The lowest number of patients needed to treat for benefit (NNTB) occurred with ibuprofen plus acetaminophen combinations: 400 mg ibuprofen plus 1000 mg acetaminophen (NNTB, 1.5; 95% CI, 1.4-1.7) and 200 mg ibuprofen plus 500 mg acetaminophen (NNTB, 1.6; 95% CI, 1.5-1.8). Low NNTBs were found in patients treated with 1000 mg acetaminophen plus 10 mg oxycodone (NNTB, 1.8; 95% CI, 1.6-2.2) and 100 mg diclofenac potassium (NNTB, 1.9; 95% CI, 1.7-2.3).

Treatments associated with a high percentage of patients experiencing ≥50% relief from maximum pain included 600 mg ibuprofen (77%), 400 mg of ibuprofen plus 1000 mg acetaminophen (72%), 200 mg ibuprofen plus 500 mg acetaminophen (69%), and 50 mg flurbiprofen (69%). Longest duration of pain relief was achieved with 1000 mg diflunisal (10.9 hours), 650 mg acetaminophen plus 10 mg oxycodone (9.9 hours), 500 mg diflunisal (9.8 hours), and 500 to 550 mg naproxen (8.9 hours). Opioid-

 "The Joint Commission's statement on pain management indicates that pain management strategies should reflect a patient-centered approach and consider the patient's current presentation, the health care providers' clinical judgment, and the risks and benefits associated with the strategies, including potential risk [for] dependency, addiction, and abuse," concluded the review authors.

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Reference

Moore PA, Ziegler KM, Lipman RD, et al. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. J Am Dent Assoc. 2018;149(4):256-265.

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