Moore Paul A, Hersh Elliot V
Department of Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, USA.
J Am Dent Assoc. 2013 Aug;144(8):898-908. doi: 10.14219/jada.archive.2013.0207.
Effective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as ibuprofen, naproxen and acetaminophen, or N-acetyl-p-aminophenol (APAP), as well as combination formulations containing opioids such as hydrocodone with APAP. The combination of ibuprofen and APAP has been advocated in the last few years as an alternative therapy for postoperative pain management. The authors conducted a critical analysis to evaluate the scientific evidence for using the ibuprofen-APAP combination and propose clinical treatment recommendations for its use in managing acute postoperative pain in dentistry.
The authors used quantitative evidence-based reviews published by the Cochrane Collaboration to determine the relative analgesic efficacy and safety of combining ibuprofen and APAP. They found additional articles by searching the Ovid MEDLINE, PubMed and ClinicalTrials.gov databases.
The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trials that also indicated that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone after third-molar extractions. The adverse effects associated with the combination were similar to those of the individual component drugs. Practical Implications. Combining ibuprofen with APAP provides dentists with an additional therapeutic strategy for managing acute postoperative dental pain. This combination has been reported to provide greater analgesia without significantly increasing the adverse effects that often are associated with opioid-containing analgesic combinations. When making stepwise recommendations for the management of acute postoperative dental pain, dentists should consider including ibuprofen-APAP combination therapy.
用于管理急性术后疼痛的有效且安全的药物治疗一直依赖于口服镇痛药，如布洛芬、萘普生和对乙酰氨基酚，或N-乙酰对氨基酚（APAP），以及含有阿片类药物的复方制剂，如氢可酮与APAP的组合。在过去几年中，布洛芬和APAP的组合已被提倡作为术后疼痛管理的替代疗法。作者进行了一项批判性分析，以评估使用布洛芬-APAP组合的科学证据，并提出其在牙科急性术后疼痛管理中应用的临床治疗建议。
作者使用Cochrane协作网发表的基于定量证据的综述来确定布洛芬和APAP联合使用的相对镇痛效果和安全性。他们通过搜索Ovid MEDLINE、PubMed和ClinicalTrials.gov数据库找到了其他文章。
定量系统评价的结果表明，与许多目前可用的含阿片类制剂相比，布洛芬-APAP组合可能是一种更有效的镇痛药，且不良反应更少。此外，作者发现几项随机对照试验也表明，在拔除第三磨牙后，布洛芬-APAP组合比单独使用布洛芬或APAP能提供更大程度的疼痛缓解。与该组合相关的不良反应与各成分药物的不良反应相似。实际意义。布洛芬与APAP联合使用为牙医提供了一种额外的治疗策略，用于管理急性术后牙科疼痛。据报道，这种组合能提供更强的镇痛效果，而不会显著增加通常与含阿片类镇痛组合相关的不良反应。在对急性术后牙科疼痛管理进行逐步推荐时，牙医应考虑纳入布洛芬-APAP联合治疗。
