Single dose oral diclofenac for acute postoperative pain in adults

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In the 15 included studies, a total of 1512 participants were treatedwith diclofenac and 793 with placebo.Diclofenac 25 mg was used in four studies (Hersh 2004; Kubitzek2003; Nelson 1994; Olson 1997), diclofenac 50 mg in 11 studies(13 treatment arms) (Ahlstrom 1993; Bakshi 1992; Bakshi 1994;Chang 2002; Cooper 1996; Herbertson 1995; Hersh 2004; Hofele2006; Mehlisch 1995; Nelson 1994; Olson 1997), diclofenac75 mg in one study (Torres 2004), and diclofenac 100 mg inseven studies (eight treatment arms) (Desjardins 2004; Herbertson1995; Hersh 2004; Mehlisch 1995; Nelson 1994; Olson 1997;Zuniga 2004).Thirteen studies used diclofenac tablets (Bakshi 1992; Bakshi1994; Chang 2002; Cooper 1996; Desjardins 2004; Herbertson1995; Mehlisch 1995; Nelson 1994; Olson 1997), three used adispersible (drinkable) preparation (Ahlstrom 1993; Bakshi 1994;Hofele 2006), and one used a softgel preparation (Zuniga 2004).Three studies used diclofenac sodium (Na) (Chang 2002; Cooper1996; Desjardins 2004), seven used diclofenac potassium (K) (Herbertson 1995; Hersh 2004; Hofele 2006; Kubitzek 2003;Mehlisch 1995; Nelson 1994; Olson 1997), two compared thesame dose of Na and K salt preparations (Bakshi 1992; Zuniga2004), one used the free acid (Bakshi 1994) and two did not specifythe salt preparation used (Ahlstrom 1993; Torres 2004).Eleven studies were in participants with dental pain following surgicalextraction of one or more impacted third molars (Ahlstrom1993; Bakshi 1992; Bakshi 1994; Chang 2002; Cooper 1996;Hersh 2004; Hofele 2006; Kubitzek 2003; Mehlisch 1995; Nelson1994; Zuniga 2004), and one each in participants with pain followingbunionectomy (Desjardins 2004), general gynaecologicalsurgery (Herbertson 1995), post episiotomy (Olson 1997), andinguinal hernia (Torres 2004).Trial duration was 6 hours in seven studies (Ahlstrom 1993; Bakshi1992; Bakshi 1994; Cooper 1996; Hersh 2004; Kubitzek 2003;Nelson 1994), eight hours in three studies (Herbertson 1995;Mehlisch 1995; Olson 1997), 24 hours in four studies (Chang2002; Desjardins 2004; Hofele 2006; Zuniga 2004), and 36 hoursin one study (Torres 2004).Risk of bias in included studiesMethodological quality of included studiesAll included studies were both randomised and double blind. Fivestudies were given a quality score of five (Chang 2002; Desjardins2004; Hersh 2004; Hofele 2006; Zuniga 2004), six a score offour (Ahlstrom 1993; Bakshi 1994; Kubitzek 2003; Nelson 1994;Mehlisch 1995; Olson 1997) and four a score of three (Bakshi1992; Cooper 1996; Herbertson 1995; Torres 2004).Full details are in the ’Characteristics of included studies’ table.Effects of interventionsAll 15 included studies provided some data for quantitative analysis.Fourteen trials contributed data to the primary efficacy outcome.One trial looking at 75 mg dose (Torres 2004) did not reportbaseline pain intensity, so that SPID could not be calculated.Number of participants achieving at least 50% painrelief (see Summary of results A)Diclofenac 25 mg versus placeboFour studies with 502 participants provided data (Hersh 2004;Kubitzek 2003; Nelson 1994; Olson 1997) (please see Table 1 andFigure 1).Figure 1.Forest plot of comparison: 1 Diclofenac 25 mg v placebo, outcome: 1.1 Participants with at least50% pain relief over 4 to 6 hours.Single dose oral diclofenac for acute postoperative pain in adults (Review)Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.6
• The proportion of participants experiencing at least 50%pain relief over 4 to 6 hours with diclofenac 25 mg was 53%(131/248; range 46% to 62%).• The proportion of participants experiencing at least 50%pain relief with placebo was 15% (37/254; range 8% to 29%).• The relative benefit of treatment compared with placebowas 3.6 (2.6 to 5.0), giving an NNT for at least 50% pain reliefover 4 to 6 hours of 2.6 (2.2 to 3.3).Diclofenac 50 mg versus placeboEleven studies (13 treatment arms) with 1325 participants provideddata (Ahlstrom 1993; Bakshi 1992; Bakshi 1994; Chang2002; Cooper 1996; Herbertson 1995; Hersh 2004; Hofele 2006;Mehlisch 1995; Nelson 1994; Olson 1997) (please see Table 1 andFigure 2).Figure 2.Forest plot of comparison: 2 Diclofenac 50 mg v placebo, outcome: 2.1 Participants with at least50% pain relief over 4 to 6 hours.Single dose oral diclofenac for acute postoperative pain in adults (Review)Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.7
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S O U R C E S O F S U P P O R TInte
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