The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Henry J Mcquay - One of the best experts on this subject based on the ideXlab platform.
-
single dose oral fenbufen for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:Background Fenbufen is a non-selective non-steroidal anti-inflammatory drug (NSAID), used to treat acute and chronic Painful conditions. There is no known systematic review of its use in acute Postoperative Pain.
-
single dose oral tiaprofenic acid for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Maura Moore, Sheena Derry, Henry J McquayAbstract:BACKGROUND: Tiaprofenic acid is a a non-steroidal anti-inflammatory drug (NSAID). It is widely available around the world, with indications for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, periarticular disorders, and strains and sprains. This review sought to evaluate the efficacy and safety of oral tiaprofenic acid in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. OBJECTIVES: To assess the efficacy of single dose oral tiaprofenic acid in acute Postoperative Pain, and any associated adverse events. SEARCH STRATEGY: We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to June 2009. SELECTION CRITERIA: Randomised, double blind, placebo-controlled trials of single dose orally administered tiaprofenic acid in adults with moderate to severe acute Postoperative Pain. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We planned to use area under the "Pain relief versus time" curve to derive the proportion of participants with tiaprofenic acid experiencing at least 50% Pain relief over 4 to 6 hours, using validated equations; to use number needed to treat to benefit (NNT); the proportion of participants using rescue analgesia over a specified time period; time to use of rescue analgesia; information on adverse events and withdrawals. MAIN RESULTS: Not one of eleven studies identified by the searches and examined in detail studied oral tiaprofenic acid against placebo in patients with established Postoperative Pain and therefore no results are available. AUTHORS' CONCLUSIONS: In the absence of evidence of efficacy for oral tiaprofenic acid in acute Postoperative Pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes which are effective, there is no urgent research agenda for this particular drug.
-
single dose oral nabumetone for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Maura Moore, Sheena Derry, Henry J McquayAbstract:Background Nabumetone is a non-steroidal anti-inflammatory drug (NSAID) used mainly in treating Pain associated with arthritis. The usual oral dose for osteoarthritis is 1000 mg daily, and higher doses are not advised in older patients. There are no known systematic reviews of its analgesic efficacy in acute Postoperative Pain. This review sought to evaluate the efficacy and safety of oral nabumetone in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish whether drugs have analgesic properties. Objectives To assess the efficacy of single dose oral nabumetone in acute Postoperative Pain, and any associated adverse events. Search methods We searched The Cochrane Library (Issue 2, 2009), MEDLINE (May 2009); EMBASE via Ovid (May 2009); and the Oxford Pain Relief Database. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of oral nabumetone for relief of acute Postoperative Pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with nabumetone and placebo experiencing at least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Main results No studies were identified by the searches that examined oral nabumetone in participants with established Postoperative Pain. Authors' conclusions In the absence of evidence of efficacy, at present, for oral nabumetone in acute Postoperative Pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes, there is no urgent research agenda.
-
single dose oral acemetacin for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:BACKGROUND Acemetacin is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral acemetacin in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. OBJECTIVES To assess the efficacy of single dose oral acemetacin in acute Postoperative Pain, and any associated adverse events. SEARCH STRATEGY We searched CENTRAL (Issue 2, 2009), MEDLINE via Ovid (1966 to May 2009); EMBASE via Ovid (1980 to May 2009); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles. SELECTION CRITERIA Randomised, double-blind, placebo-controlled clinical trials of oral acemetacin for relief of acute Postoperative Pain in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with acemetacin and placebo experiencing least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals. The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. MAIN RESULTS No study fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS In the absence of randomised evidence of efficacy for oral acemetacin in acute Postoperative Pain, we cannot, at present, make any conclusions regarding its effectiveness. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this kind and similar classes, there is no urgent research agenda for this drug.
-
single dose oral aceclofenac for Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:Background Aceclofenac is the prodrug of the non-steroidal anti-inflammatory drug (NSAID) diclofenac, widely used to treat acute and chronic Pain. There are no known systematic reviews of its analgesic efficacy in acute Postoperative Pain. This review sought to evaluate the efficacy and safety of oral aceclofenac in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. Objectives To assess the efficacy of single dose oral aceclofenac in acute Postoperative Pain, and any associated adverse events. Search strategy We searched The Cochrane Library (Issue 1, 2009), MEDLINE via Ovid (1966 to March 2009); EMBASE via Ovid (1980 to March 2009); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of oral aceclofenac for relief of acute Postoperative Pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with paracetamol plus codeine and placebo or paracetamol alone experiencing least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Main results Searches identified only one study (217 participants total), which used oral aceclofenac 150 mg in patients with established Postoperative Pain. Aceclofenac 150 mg could not be distinguished from placebo, though ibuprofen 400 mg was distinguished from placebo. Authors' conclusions In the absence of evidence of efficacy for oral aceclofenac in acute Postoperative Pain (at least at 150 mg single dose), its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies are lacking, use in other indications should be evaluated carefully. Given the large number of effective drugs available in this and similar classes of analgesics, there is no urgent research agenda required to demonstrate the effective dose of aceclofenac in acute Postoperative Pain.
Andrew R Moore - One of the best experts on this subject based on the ideXlab platform.
-
single dose oral fenbufen for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:Background Fenbufen is a non-selective non-steroidal anti-inflammatory drug (NSAID), used to treat acute and chronic Painful conditions. There is no known systematic review of its use in acute Postoperative Pain.
-
single dose oral tiaprofenic acid for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Maura Moore, Sheena Derry, Henry J McquayAbstract:BACKGROUND: Tiaprofenic acid is a a non-steroidal anti-inflammatory drug (NSAID). It is widely available around the world, with indications for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, periarticular disorders, and strains and sprains. This review sought to evaluate the efficacy and safety of oral tiaprofenic acid in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. OBJECTIVES: To assess the efficacy of single dose oral tiaprofenic acid in acute Postoperative Pain, and any associated adverse events. SEARCH STRATEGY: We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to June 2009. SELECTION CRITERIA: Randomised, double blind, placebo-controlled trials of single dose orally administered tiaprofenic acid in adults with moderate to severe acute Postoperative Pain. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We planned to use area under the "Pain relief versus time" curve to derive the proportion of participants with tiaprofenic acid experiencing at least 50% Pain relief over 4 to 6 hours, using validated equations; to use number needed to treat to benefit (NNT); the proportion of participants using rescue analgesia over a specified time period; time to use of rescue analgesia; information on adverse events and withdrawals. MAIN RESULTS: Not one of eleven studies identified by the searches and examined in detail studied oral tiaprofenic acid against placebo in patients with established Postoperative Pain and therefore no results are available. AUTHORS' CONCLUSIONS: In the absence of evidence of efficacy for oral tiaprofenic acid in acute Postoperative Pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes which are effective, there is no urgent research agenda for this particular drug.
-
single dose oral nabumetone for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Maura Moore, Sheena Derry, Henry J McquayAbstract:Background Nabumetone is a non-steroidal anti-inflammatory drug (NSAID) used mainly in treating Pain associated with arthritis. The usual oral dose for osteoarthritis is 1000 mg daily, and higher doses are not advised in older patients. There are no known systematic reviews of its analgesic efficacy in acute Postoperative Pain. This review sought to evaluate the efficacy and safety of oral nabumetone in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish whether drugs have analgesic properties. Objectives To assess the efficacy of single dose oral nabumetone in acute Postoperative Pain, and any associated adverse events. Search methods We searched The Cochrane Library (Issue 2, 2009), MEDLINE (May 2009); EMBASE via Ovid (May 2009); and the Oxford Pain Relief Database. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of oral nabumetone for relief of acute Postoperative Pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with nabumetone and placebo experiencing at least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Main results No studies were identified by the searches that examined oral nabumetone in participants with established Postoperative Pain. Authors' conclusions In the absence of evidence of efficacy, at present, for oral nabumetone in acute Postoperative Pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes, there is no urgent research agenda.
-
single dose oral acemetacin for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:BACKGROUND Acemetacin is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral acemetacin in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. OBJECTIVES To assess the efficacy of single dose oral acemetacin in acute Postoperative Pain, and any associated adverse events. SEARCH STRATEGY We searched CENTRAL (Issue 2, 2009), MEDLINE via Ovid (1966 to May 2009); EMBASE via Ovid (1980 to May 2009); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles. SELECTION CRITERIA Randomised, double-blind, placebo-controlled clinical trials of oral acemetacin for relief of acute Postoperative Pain in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with acemetacin and placebo experiencing least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals. The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. MAIN RESULTS No study fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS In the absence of randomised evidence of efficacy for oral acemetacin in acute Postoperative Pain, we cannot, at present, make any conclusions regarding its effectiveness. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this kind and similar classes, there is no urgent research agenda for this drug.
-
single dose oral aceclofenac for Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:Background Aceclofenac is the prodrug of the non-steroidal anti-inflammatory drug (NSAID) diclofenac, widely used to treat acute and chronic Pain. There are no known systematic reviews of its analgesic efficacy in acute Postoperative Pain. This review sought to evaluate the efficacy and safety of oral aceclofenac in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. Objectives To assess the efficacy of single dose oral aceclofenac in acute Postoperative Pain, and any associated adverse events. Search strategy We searched The Cochrane Library (Issue 1, 2009), MEDLINE via Ovid (1966 to March 2009); EMBASE via Ovid (1980 to March 2009); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of oral aceclofenac for relief of acute Postoperative Pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with paracetamol plus codeine and placebo or paracetamol alone experiencing least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Main results Searches identified only one study (217 participants total), which used oral aceclofenac 150 mg in patients with established Postoperative Pain. Aceclofenac 150 mg could not be distinguished from placebo, though ibuprofen 400 mg was distinguished from placebo. Authors' conclusions In the absence of evidence of efficacy for oral aceclofenac in acute Postoperative Pain (at least at 150 mg single dose), its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies are lacking, use in other indications should be evaluated carefully. Given the large number of effective drugs available in this and similar classes of analgesics, there is no urgent research agenda required to demonstrate the effective dose of aceclofenac in acute Postoperative Pain.
Sheena Derry - One of the best experts on this subject based on the ideXlab platform.
-
single dose oral fenbufen for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:Background Fenbufen is a non-selective non-steroidal anti-inflammatory drug (NSAID), used to treat acute and chronic Painful conditions. There is no known systematic review of its use in acute Postoperative Pain.
-
single dose oral tiaprofenic acid for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Maura Moore, Sheena Derry, Henry J McquayAbstract:BACKGROUND: Tiaprofenic acid is a a non-steroidal anti-inflammatory drug (NSAID). It is widely available around the world, with indications for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, periarticular disorders, and strains and sprains. This review sought to evaluate the efficacy and safety of oral tiaprofenic acid in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. OBJECTIVES: To assess the efficacy of single dose oral tiaprofenic acid in acute Postoperative Pain, and any associated adverse events. SEARCH STRATEGY: We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to June 2009. SELECTION CRITERIA: Randomised, double blind, placebo-controlled trials of single dose orally administered tiaprofenic acid in adults with moderate to severe acute Postoperative Pain. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We planned to use area under the "Pain relief versus time" curve to derive the proportion of participants with tiaprofenic acid experiencing at least 50% Pain relief over 4 to 6 hours, using validated equations; to use number needed to treat to benefit (NNT); the proportion of participants using rescue analgesia over a specified time period; time to use of rescue analgesia; information on adverse events and withdrawals. MAIN RESULTS: Not one of eleven studies identified by the searches and examined in detail studied oral tiaprofenic acid against placebo in patients with established Postoperative Pain and therefore no results are available. AUTHORS' CONCLUSIONS: In the absence of evidence of efficacy for oral tiaprofenic acid in acute Postoperative Pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes which are effective, there is no urgent research agenda for this particular drug.
-
single dose oral nabumetone for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Maura Moore, Sheena Derry, Henry J McquayAbstract:Background Nabumetone is a non-steroidal anti-inflammatory drug (NSAID) used mainly in treating Pain associated with arthritis. The usual oral dose for osteoarthritis is 1000 mg daily, and higher doses are not advised in older patients. There are no known systematic reviews of its analgesic efficacy in acute Postoperative Pain. This review sought to evaluate the efficacy and safety of oral nabumetone in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish whether drugs have analgesic properties. Objectives To assess the efficacy of single dose oral nabumetone in acute Postoperative Pain, and any associated adverse events. Search methods We searched The Cochrane Library (Issue 2, 2009), MEDLINE (May 2009); EMBASE via Ovid (May 2009); and the Oxford Pain Relief Database. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of oral nabumetone for relief of acute Postoperative Pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with nabumetone and placebo experiencing at least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Main results No studies were identified by the searches that examined oral nabumetone in participants with established Postoperative Pain. Authors' conclusions In the absence of evidence of efficacy, at present, for oral nabumetone in acute Postoperative Pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes, there is no urgent research agenda.
-
single dose oral acemetacin for acute Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:BACKGROUND Acemetacin is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral acemetacin in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. OBJECTIVES To assess the efficacy of single dose oral acemetacin in acute Postoperative Pain, and any associated adverse events. SEARCH STRATEGY We searched CENTRAL (Issue 2, 2009), MEDLINE via Ovid (1966 to May 2009); EMBASE via Ovid (1980 to May 2009); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles. SELECTION CRITERIA Randomised, double-blind, placebo-controlled clinical trials of oral acemetacin for relief of acute Postoperative Pain in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with acemetacin and placebo experiencing least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals. The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. MAIN RESULTS No study fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS In the absence of randomised evidence of efficacy for oral acemetacin in acute Postoperative Pain, we cannot, at present, make any conclusions regarding its effectiveness. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this kind and similar classes, there is no urgent research agenda for this drug.
-
single dose oral aceclofenac for Postoperative Pain in adults
Cochrane Database of Systematic Reviews, 2009Co-Authors: Andrew R Moore, Sheena Derry, Henry J McquayAbstract:Background Aceclofenac is the prodrug of the non-steroidal anti-inflammatory drug (NSAID) diclofenac, widely used to treat acute and chronic Pain. There are no known systematic reviews of its analgesic efficacy in acute Postoperative Pain. This review sought to evaluate the efficacy and safety of oral aceclofenac in acute Postoperative Pain, using clinical studies of patients with established Pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. Objectives To assess the efficacy of single dose oral aceclofenac in acute Postoperative Pain, and any associated adverse events. Search strategy We searched The Cochrane Library (Issue 1, 2009), MEDLINE via Ovid (1966 to March 2009); EMBASE via Ovid (1980 to March 2009); the Oxford Pain Relief Database (1950 to 1994); and reference lists of articles. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of oral aceclofenac for relief of acute Postoperative Pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. The area under the "Pain relief versus time" curve was used to derive the proportion of participants with paracetamol plus codeine and placebo or paracetamol alone experiencing least 50% Pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Main results Searches identified only one study (217 participants total), which used oral aceclofenac 150 mg in patients with established Postoperative Pain. Aceclofenac 150 mg could not be distinguished from placebo, though ibuprofen 400 mg was distinguished from placebo. Authors' conclusions In the absence of evidence of efficacy for oral aceclofenac in acute Postoperative Pain (at least at 150 mg single dose), its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute Pain studies are lacking, use in other indications should be evaluated carefully. Given the large number of effective drugs available in this and similar classes of analgesics, there is no urgent research agenda required to demonstrate the effective dose of aceclofenac in acute Postoperative Pain.
Ashraf S. Habib - One of the best experts on this subject based on the ideXlab platform.
-
acupuncture and related techniques for Postoperative Pain a systematic review of randomized controlled trials
BJA: British Journal of Anaesthesia, 2008Co-Authors: Y Sun, Tong J Gan, J W Dubose, Ashraf S. HabibAbstract:Postoperative Pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute Postoperative Pain management. We searched the databases of Medline (1966‐2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials (RCTs) using acupuncture for Postoperative Pain management. We extracted data about Postoperative opioid consumption, Postoperative Pain intensity, and opioid-related side-effects. Combined data were analysed using a random effects model. Fifteen RCTs comparing acupuncture with sham control in the management of acute Postoperative Pain were included. Weighted mean difference for cumulative opioid analgesic consumption was 23.14 mg (95% confidence interval, CI: 25.15, 21.14), 28.33 mg (95% CI: 211.06, 25.61), and 29.14 mg (95% CI: 216.07, 22.22) at 8, 24, and 72 h, respectively. Postoperative Pain intensity (visual analogue scale, 0‐100 mm) was also significantly decreased in the acupuncture group at 8 and 72 h compared with the control group. The acupuncture treatment group was associated with a lower incidence of opioid-related side-effects such as nausea (relative risk, RR: 0.67; 95% CI: 0.53, 0.86), dizziness (RR: 0.65; 95% CI: 0.52, 0.81), sedation (RR: 0.78; 95% CI: 0.61, 0.99), pruritus (RR: 0.75; 95% CI: 0.59, 0.96), and urinary retention (RR: 0.29; 95% CI: 0.12, 0.74). Perioperative acupuncture may be a useful adjunct for acute Postoperative Pain management. Br J Anaesth 2008; 101: 151‐60
-
gabapentin and Postoperative Pain a systematic review of randomized controlled trials
Pain, 2006Co-Authors: Kokyuen Ho, Ashraf S. HabibAbstract:Abstract The objective of this systematic review was to evaluate the efficacy and tolerability of perioperative gabapentin administration for the control of acute Postoperative Pain. We searched Medline (1966–2006), the Cochrane Library (2006), Scopus, CINAHL and bibliographies from clinical trials and review articles. We included randomized controlled trials (RCTs) comparing gabapentin with inactive controls in surgical patients. Sixteen valid RCTs were included. Weighted mean difference (WMD) for Postoperative Pain intensity (0–100 mm visual analogue scale) was −16.55 mm at 6 h and −10.87 mm at 24 h for treatment with a single preoperative dose of gabapentin 1200 mg. Cumulative opioid consumption at 24 h was also significantly decreased with gabapentin (WMD, −27.90 mg). When gabapentin was administered at doses less than 1200 mg, Pain intensity was also lower at 6 h (WMD, −22.43 mm) and 24 h (WMD, −13.18 mm). Cumulative 24 h opioid consumption was also lower (WMD, −7.25 mg). Gabapentin was associated with an increased risk of sedation (Peto OR 3.86; 95% CI 2.50–5.94) but less opioid-related side effects such as vomiting (Peto OR 0.58; 95% CI 0.39–0.86) and pruritus (Peto OR 0.27; 95% CI 0.10–0.74). In conclusion, gabapentin has an analgesic and opioid-sparing effect in acute Postoperative Pain management when used in conjunction with opioids.
Paul F White - One of the best experts on this subject based on the ideXlab platform.
-
improving Postoperative Pain management what are the unresolved issues
Anesthesiology, 2010Co-Authors: Paul F White, Henrik KehletAbstract:DESPITE recent advances in our understanding of the physiology of acute Pain, the development of new opioid and nonopioid analgesics and novel methods of drug delivery, and more widespread use of Pain-reducing minimally invasive surgical techniques, Pain after surgical procedures remains a challenge for many practitioners. Not surprisingly, recent surveys in the United States and Europe have emphasized the insufficient quality of Postoperative Pain management and the need for further improvements. The increasing implementation of standardized Pain evaluation and treatment protocols, and the use of multimodal analgesic techniques, are hopeful signs that improvements in Pain management are likely to continue in the years ahead. What then are the major unresolved issues in the management of acute Postoperative Pain, and how should surgical patients bemanaged based on the available evidence from the peer-reviewed medical literature?
-
multimodal analgesia its role in preventing Postoperative Pain
Current opinion in investigational drugs, 2008Co-Authors: Paul F WhiteAbstract:Postoperative Pain is a complex and multifactorial symptom that requires a thoughtful approach using a variety of treatment modalities to obtain an optimal outcome after surgery. Multimodal (or 'balanced') analgesia represents an approach to preventing Postoperative Pain where the patient is administered a combination of opioid and non-opioid analgesic drugs that act at different sites within the central and peripheral nervous systems in an effort to minimize opioid use and, therefore, to decrease opioid-related side effects. Despite widespread interest in this concept from both the anesthesia and surgery communities, very few prospective, randomized, controlled clinical investigations have been conducted that utilize this approach to improving patient comfort and facilitating recovery after surgery. Most of the published studies focus on the effects of a single therapeutic modality when it is added to an existing analgesic regimen. More recently, clinical investigators have begun to examine the beneficial effects of combined multimodal approaches in preventing Postoperative Pain by utilizing combinations of non-opioid analgesics to minimize the opioid analgesic requirements and opioid-related side effects. This review explores the theoretical basis for multimodal analgesia and the existing scientific evidence supporting its benefit in improving Pain control after surgery. Recent investigations that have examined the impact of this therapeutic approach for improving clinically meaningful patient outcomes after surgery will be discussed.
