单剂量口服布洛芬和双氯芬酸用于术后疼痛。

Single dose oral ibuprofen and diclofenac for postoperative pain.

作者信息

Collins S L, Moore R A, McQuay H J, Wiffen P J, Edwards J E

机构信息

Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Old Road, Oxford, UK, OX3 7LJ.

出版信息

Cochrane Database Syst Rev. 2000(2):CD001548. doi: 10.1002/14651858.CD001548.

DOI:10.1002/14651858.CD001548

PMID:10796811

Abstract

BACKGROUND

Ibuprofen and diclofenac are two widely used non-steroidal anti-inflammatory (NSAID) analgesics. It is therefore important to know which drug should be recommended for postoperative pain relief. This review seeks to compare the relative efficacy of the two drugs, and also considers the issues of safety and cost.

OBJECTIVES

To assess the analgesic efficacy of ibuprofen and diclofenac in single oral doses for moderate to severe postoperative pain.

SEARCH STRATEGY

Randomised trials were identified by searching Medline (1966 to December 1996), Embase (1980 to January 1997), the Cochrane Library (Issue 3 1996), Biological Abstracts (January 1985 to December 1996) and the Oxford Pain Relief Database (1950 to 1994). Date of the most recent searches: July 1998.

SELECTION CRITERIA

The inclusion criteria used were: full journal publication, postoperative pain, postoperative oral administration, adult patients, baseline pain of moderate to severe intensity, double-blind design, and random allocation to treatment groups which compared either ibuprofen or diclofenac with placebo.

DATA COLLECTION AND ANALYSIS

Data were extracted by two independent reviewers, and trials were quality scored. Summed pain relief or pain intensity difference over four to six hours was extracted, and converted into dichotomous information yielding the number of patients with at least 50% pain relief. This was then used to calculate the relative benefit and the number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief.

MAIN RESULTS

Thirty-four trials compared ibuprofen and placebo (3,591 patients), six compared diclofenac with placebo (840 patients) and there were two direct comparisons of diclofenac 50 mg and ibuprofen 400 mg (130 patients). In postoperative pain the NNTs for ibuprofen 200 mg were 3.3 (95% confidence interval 2.8 to 4.0) compared with placebo, for ibuprofen 400 mg 2.7 (2.5 to 3.0), for ibuprofen 600 mg 2.4 (1.9 to 3.3), for diclofenac 50 mg 2.3 (2.0 to 2.7) and for diclofenac 100 mg 1.8 (1.5 to 2.1). Direct comparisons of diclofenac 50 mg with ibuprofen 400 mg showed no significant difference between the two.

REVIEWER'S CONCLUSIONS: Both drugs work well. Choosing between them is an issue of dose, safety and cost.

摘要

背景

布洛芬和双氯芬酸是两种广泛使用的非甾体抗炎（NSAID）镇痛药。因此，了解应推荐哪种药物用于术后疼痛缓解很重要。本综述旨在比较这两种药物的相对疗效，并考虑安全性和成本问题。

目的

评估布洛芬和双氯芬酸单次口服剂量对中度至重度术后疼痛的镇痛效果。

检索策略

通过检索医学索引数据库（1966年至1996年12月）、荷兰医学文摘数据库（1980年至1997年1月）、考克兰图书馆（1996年第3期）、生物学文摘数据库（1985年1月至1996年12月）和牛津疼痛缓解数据库（1950年至1994年）来确定随机试验。最近一次检索日期：1998年7月。

选择标准

所使用的纳入标准为：完整的期刊发表、术后疼痛、术后口服给药、成年患者、中度至重度强度的基线疼痛、双盲设计以及随机分配至将布洛芬或双氯芬酸与安慰剂进行比较的治疗组。

数据收集与分析

由两名独立的审阅者提取数据，并对试验进行质量评分。提取四至六小时内的总疼痛缓解或疼痛强度差异，并将其转换为二分信息，得出至少有50%疼痛缓解的患者数量。然后用此计算相对益处和一名患者实现至少50%疼痛缓解所需的治疗人数（NNT）。

主要结果

34项试验比较了布洛芬与安慰剂（3591例患者），6项试验比较了双氯芬酸与安慰剂（840例患者），有两项试验对50毫克双氯芬酸和400毫克布洛芬进行了直接比较（130例患者）。在术后疼痛中，与安慰剂相比，200毫克布洛芬的NNT为3.3（95%置信区间2.8至4.0），400毫克布洛芬为2.7（2.5至3.0），600毫克布洛芬为2.4（1.9至3.3），50毫克双氯芬酸为2.3（2.0至2.7），100毫克双氯芬酸为1.8（1.5至2.1）。50毫克双氯芬酸与400毫克布洛芬的直接比较显示两者之间无显著差异。