Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions Translating clinical research to dental practice
Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions Translating clinical research to dental practice
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DOI：
10.14219/jada.archive.2013.0207
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发表时间：
2013-08-01
影响因子：
3.9
通讯作者：
Hersh, Elliot V.
中科院分区：
文献类型：
--
作者：
Moore, Paul A.;Hersh, Elliot V.
背景资料。术后急性疼痛的有效和安全的药物治疗依赖于口服止痛剂如布洛芬、萘普生和对乙酰氨基酚(APAP)，以及含有阿片类药物的组合制剂，如氢可酮和APAP。在过去的几年里，布洛芬和APAP作为术后疼痛管理的一种替代疗法一直被提倡。作者进行了一项批判性分析，以评估使用布洛芬-APAP联合应用的科学证据，并就其在牙科急性术后疼痛控制中的应用提出临床治疗建议。作者使用Cochrane Collaboration发表的定量循证综述来确定布洛芬和APAP联合应用的相对止痛有效性和安全性。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，布洛芬-APAP组合可能是一种比目前许多现有的含有阿片类药物的制剂更有效、不良反应更少的止痛剂。此外，作者还发现了几个随机对照试验，这些试验也表明，在拔除第三磨牙后，布洛芬和APAP联合使用比单独使用布洛芬或APAP提供了更好的止痛效果。联合用药的不良反应与单独用药的副作用相似。布洛芬与APAP的结合为牙科医生提供了一种治疗急性术后牙痛的额外治疗策略。据报道，这种联合用药可以提供更好的止痛效果，而不会显著增加阿片类止痛药联合用药的不良反应。当对急性术后牙痛的治疗提出阶段性建议时，牙医应考虑布洛芬-APAP联合治疗。
Background. 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.Types of Studies Reviewed. 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.Conclusions. 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.