Analgesic efficacy of ibuprofen alone and in combination with codeine or caffeine in post-surgical pain: a meta-analysis.
OBJECTIVE
To estimate the analgesic effect of ibuprofen and to test whether codeine and caffeine enhance its effect on post-surgical pain.


METHODS
Systematic overview of the literature and meta-analysis of published randomised, controlled trials.


RESULTS
Ibuprofen is effective in dental pain, episiotomy pain and other post-operative pain. There is a dose response relationship over the range 50-400 mg. The difference in total pain-relief score relative to placebo was 19-31%. On average, patients were over three times more likely to obtain moderate to excellent pain relief with ibuprofen than with placebo (response-rate ratio = 3.45) and the number needed to treat was 2.44. Codeine 60 mg enhanced the analgesic effect of ibuprofen 400 mg by about 8% in the total pain-relief scale, but it also increased its adverse effects. The additive effect of caffeine was inconsistent.


CONCLUSIONS
Ibuprofen is an effective analgesic in post-operative pain. Codeine 60 mg adds to the analgesic effect of ibuprofen 400 mg. Any additive caffeine effect requires validation.
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Centre for Evidence-Based Pharmacotherapy, Department of Pharmaceutical Sciences, The University of Nottingham, UK.
Zhang
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D000328:Adult; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D002110:Caffeine / Q000008:administration & dosage; D003061:Codeine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012894:Sleep Stages
D019162:Anesthetics, Combined; D002110:Caffeine; D003061:Codeine; D007052:Ibuprofen