title: Controlled-release codeine is equivalent to acetaminophen plus codeine for post-cholecystectomy analgesia.
abstract: OBJECTIVE
  Following ambulatory surgery, long-acting analgesics may provide advantages over short-acting analgesics. This study compared controlled-release codeine (CC) and acetaminophen plus codeine (A/C; 300 mg/30 mg) for pain control in the 48-hr period following laparoscopic cholecystectomy.
  
  
  METHODS
  Eligible patients were randomized to CC or A/C in a double-blind, double-dummy parallel group study. Unrelieved pain in hospital was treated with fentanyl i.v. bolus. Pain [100 mm visual analogue scale (VAS)] was assessed before the first dose of medication; at 0.5, one, two, three, and four hours post-dose; at discharge; and three times a day for 48 hr. Adverse events were recorded and measures of patient satisfaction were assessed at the end of the study.
  
  
  RESULTS
  Eighty-four patients were enrolled in the study; 42 patients in each group. There were no statistically significant differences between CC and A/C treatment. Mean VAS baseline pain was similar in both groups (P = 0.49) and there was no significant difference in the time to onset of analgesia (P = 0.17). At 0.5 hr, the mean VAS pain score was significantly reduced from baseline in both groups (P = 0.0001). The VAS pain scores at discharge were reduced 59% and 56% from baseline, respectively (P = 0.61). There was no difference between treatments in the incidence of adverse events and patients reported similar levels of satisfaction.
  
  
  CONCLUSIONS
  Controlled-release codeine provides an equivalent onset of analgesia, reduction in postoperative pain, and level of patient satisfaction, to acetaminophen plus codeine, over 48 hr following cholecystectomy, with the advantage of less frequent dosing.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. frances.chung@uhn.on.ca
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.forename: Doris
authors.initials: D
authors.lastname: Tong
authors.forename: Paula C
authors.initials: PC
authors.lastname: Miceli
authors.forename: Joseph
authors.initials: J
authors.lastname: Reiz
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Harsanyi
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Darke
authors.forename: Lance W
authors.initials: LW
authors.lastname: Payne
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D003061:Codeine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000082:Acetaminophen; D003061:Codeine