Analgesic efficacy and safety of Acetaminophen -Codeine combination versus acetaminophen for post operative analgesia in third molar surgery
Background: Post operative dental pain is frequently treated with codeine added to paracetamol; Studies have shown effectiveness in relief of post-operative pain at high doses but at the expense of central nervous and gastrointestinal side effects. This trial was to compare the efficacy and safety of paracetamol 1000mg with paracetamol 1000mg combined with codeine 30mg in treatment of post operative pain after third molar surgery.
Method: A randomized, double-blind prospective trial was performed to compare paracetamol 1000mg with paracetamol 1000mg with codeine 30mg for the relief of pain following surgical removal of impacted third molars, and analysed using a VAS scale. Forty patients were assigned randomly to receive either drug for a maximum of three doses. Patients recorded their pain intensity one hour after surgery and hourly thereafter for 6 hours.
Results: The average increase in pain intensity over 6 hours was significantly less in patients receiving paracetamol plus codeine than in those receiving paracetamol alone (p=0.03) -1.81cm/h compared with 0.45cm/h – a difference of 1.13cm/h (95 per cent Cl: 0.18 to 2.08). Of the patients who received Acetaminophen codeine combination, 62 per cent used rescue analgesics compared with 75 per cent of those on acetaminophen (p=0.20). There was no significant difference between the two groups in the proportion of patients experiencing adverse events (p=0.5).
Conclusion: A combination of 1000mg acetaminophen and 30mg codeine was effective in controlling pain for 6 hours following third molar removal, with no significant difference of side effects during the 6 hour period studied.
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