NSAIDs give outpatient surgery patients better pain relief than codeine

Nonsteroidal anti-inflammatory drugs (NSAIDs) give outpatient surgery patients better post-operative pain relief and fewer adverse effects than codeine. But acetaminophen seems to play an extra role, according to a study published in the CMAJ. Codeine use is widespread in the outpatient surgery setting and is the most commonly prescribed opioid in Canada. “However, its efficacy is variable, its potency is low and its use is associated with risks of severe adverse effects and misuse. Amid the ongoing opioid crisis, management of pain and potential opioid misuse is important across all medical and dental specialties,” the study said. Read: The case for cracking down on codeine NSAIDs are an alternative to low-potency opioids and some studies found their use can reduce opioid consumption in postoperative patients. The potency and toxicity of NSAIDs depend on the degree to which they inhibit cyclooxygenase 1 and 2 activity. In a systematic review and meta-analysis of randomized-controlled trials (RCTs), researchers compared the effectiveness of codeine and NSAIDs in adult outpatient surgery patients. A total of 40 studies representing 102 trial arms and 5,116 patients from the MEDLINE and Embase databases covering several decades were used. The goal was to compare pain and safety outcomes for codeine-based medications and NSAIDs with a primary outcome of efficacy (pain levels measured by a validated pain scale). Secondary outcomes included adverse effects. Read: A prescription to help combat opioid addiction? RCTs were included if they compared oral codeine with oral NSAIDs prescribed to treat adult outpatients with acute postoperative pain. The types and doses of NSAIDs used varied, and codeine doses ranged from 15 mg to 90 mg. Pain levels at 6 hours or less after treatment was reported for 4,436 patients from 54 trial arm comparisons. It was found that patients who received NSAIDs had lower pain scores than those who received codeine. “When comparing studies that either did not co-administer acetaminophen or used it with both NSAID and codeine groups, we found that patients using NSAIDs had even lower pain scores…NSAIDs had weaker superiority when acetaminophen was co-administered only with the codeine group,” the study said. Pain at 12 hours or less after treatment was reported for a total of 1,660 patients. Here, patients who received NSAIDs had lower pain scores than those who received codeine. “We found that patients randomized to NSAIDs following outpatient surgical procedures reported better pain scores, better global assessment scores, fewer adverse effects and no difference in bleeding events, compared with those receiving codeine," the study said.

NSAIDs give outpatient surgery patients better pain relief than codeine

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