Ferraiolo Debra M, Veitz-Keenan Analia
NYU College of Dentistry, New York, USA.
Evid Based Dent. 2014 Dec;15(4):106-7. doi: 10.1038/sj.ebd.6401059.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and the metaRegister of Controlled Trials were searched with no language restrictions.
Randomised controlled double-blinded clinical trials using the third molar model were included.
Two review authors independently and in duplicate extracted data. The proportion of patients with at least 50% pain relief (based on total pain relief (TOTPAR) and summed pain intensity difference (SPID) data) was calculated for all three drugs at both two and six hours post-dosing and meta-analysed for comparison.
Seven studies involving 2241 patients were included. Two studies were considered to be at low risk of bias, three at high risk and two unclear risk of bias. Ibuprofen was found to be a superior analgesic to paracetamol at several doses, with high quality evidence suggesting that ibuprofen 400 mg is superior to 1000 mg paracetamol based on pain relief (estimated from TOTPAR data) and the use of rescue medication meta-analyses. Risk ratio (RR) for at least 50% pain relief (based on TOTPAR) at six hours was 1.47 (95% confidence interval (CI) 1.28 to 1.69; five trials) favouring 400 mg ibuprofen over 1000 mg paracetamol, RR for not using rescue medication (also favouring ibuprofen) was 1.50 (95% CI 1.25 to 1.79; four trials). For combined drug RR for at least 50% of the maximum pain relief over six hours of 1.77 (95% CI 1.32 to 2.39) (paracetamol 1000 mg and ibuprofen 400 mg) (one trial; moderate quality evidence). RR not using rescue medication 1.60 (95% CI 1.36 to 1.88) (two trials; moderate quality evidence). Adverse events were comparable between the treatment groups, but no formal analysis could be undertaken.
There is high quality evidence that ibuprofen is superior to paracetamol at doses of 200 mg to 512 mg and 600 mg to 1000 mg respectively based on pain relief and use of rescue medication data collected at six hours postoperatively. The majority of this evidence (five out of six trials) compared ibuprofen 400 mg with paracetamol 1000 mg, these are the most frequently prescribed doses in clinical practice. The novel combination drug is showing encouraging results based on the outcomes from two trials when compared to the single drugs.
检索了Cochrane口腔健康小组试验注册库、Cochrane对照试验中央注册库（CENTRAL）、医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）以及对照试验元注册库，无语言限制。
纳入使用第三磨牙模型的随机对照双盲临床试验。
两位综述作者独立且重复提取数据。计算给药后两小时和六小时时，三种药物治疗的患者中疼痛缓解至少50%（基于总疼痛缓解率（TOTPAR）和疼痛强度差值总和（SPID）数据）的比例，并进行荟萃分析以作比较。
纳入七项研究，共2241例患者。两项研究被认为偏倚风险较低，三项偏倚风险较高，两项偏倚风险不明。发现布洛芬在几个剂量下都是比扑热息痛更有效的镇痛药，高质量证据表明，基于疼痛缓解（根据TOTPAR数据估算）和救援药物荟萃分析，400毫克布洛芬优于1000毫克扑热息痛。六小时时疼痛缓解至少50%（基于TOTPAR）的风险比（RR）为1.47（95%置信区间（CI）1.28至1.69；五项试验），表明400毫克布洛芬优于1000毫克扑热息痛；未使用救援药物的RR（也支持布洛芬）为1.50（95%CI 1.25至1.79；四项试验）。对于联合用药，六小时内疼痛缓解至少达到最大疼痛缓解50%的RR为1.77（95%CI 1.32至2.39）（扑热息痛1000毫克和布洛芬400毫克）（一项试验；中等质量证据）。未使用救援药物的RR为1.60（95%CI 1.36至1.88）（两项试验；中等质量证据）。各治疗组之间不良事件相当，但未进行正式分析。
基于术后六小时收集的疼痛缓解和救援药物使用数据，有高质量证据表明，布洛芬在剂量分别为200毫克至512毫克和600毫克至1000毫克时优于扑热息痛。这些证据中的大多数（六项试验中的五项）将400毫克布洛芬与1000毫克扑热息痛进行了比较，这是临床实践中最常用的处方剂量。与单一药物相比，基于两项试验的结果，这种新型复方药物显示出令人鼓舞的效果。
