SINGLE-DOSE DEXTROPROPOXYPHENE IN POSTOPERATIVE PAIN - A QUANTITATIVESYSTEMATIC REVIEW

Objective: To determine the analgesic efficacy and adverse effects of single-dose oral dextropropoxyphene alone and in combination with para cetamol for moderate to severe post-operative pain. Methods: Published reports were identified from a variety of electronic databases includ ing MEDLINE, Biological Abstracts, EMBASE, the Cochrane Library and th e Oxford Pain Relief Database. Additional studies were identified from the reference lists of retrieved reports. Summed pain intensity and p ain relief data were extracted and converted into dichotomous informat ion to yield the number of patients with at least 50% pain relief. Thi s was used to calculate the relative benefit and number-needed-to-trea t for one patient to achieve at least 50% pain relief. Six reports (44 0 patients) compared dextropropoxyphene with placebo and five (963 pat ients) compared dextropropoxyphene plus paracetamol 650 mg with placeb o. Results: For a single dose of dextropropoxyphene 65 mg in post-oper ative pain the number-needed-to-treat for at least 50% pain relief was 7.7 (95% confidence interval 4.6 to 22) when compared with placebo ov er 4-6 h. For the equivalent dose of dextropropoxyphene in combination with paracetamol 650 mg the number-needed-to-treat was 4.4 (3.5 to 5. 6) when compared with placebo. Pooled data showed increased incidence of central nervous system adverse effects for dextropropoxyphene plus paracetamol when compared with placebo. A rank order of single-dose an algesic effectiveness in post-operative pain of moderate to severe int ensity obtained from similar systematic reviews is presented. Conclusi on: Dextropropoxyphene 65 mg plus paracetamol 650 mg has a similar ana lgesic efficacy to that of tramadol 100 mg but with a lower incidence of adverse effects. Ibuprofen 400 mg has a lower (better) number-neede d-to-treat than both dextropropoxyphene 65 mg plus paracetamol 650 mg and tramadol 100 mg.