After outpatient surgery, NSAIDs top codeine for pain control with less side-effects

When prescribed following outpatient surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen provide better pain control with less side-effects than the opioid codeine. Researchers reported these findings on June 14, 2021 in CMAJ/Canadian Medical Association Journal.

“In all surgery types, subgroups and outcome time points, NSAIDs were equal or superior to codeine for postoperative pain,” said investigator Matthew Choi, MD, Associate Professor of Surgery, McMaster University, Hamilton, Ontario, Canada.

As background for their study, the authors noted that, “Analgesics that contain codeine are commonly prescribed for postoperative pain, but it is unclear how they compare with nonopioid alternatives. We sought to compare the effectiveness of codeine and nonsteroidal anti-inflammatory drugs (NSAIDs) for adults who underwent outpatient surgery.

The investigators conducted a meta-analysis of relevant randomized controlled trials, comparing codeine and NSAIDs for postoperative pain in outpatient surgery.

They searched standard data bases for eligible studies. Forty studies enrolling 5,116 patients met inclusion criteria

The primary outcome for the new analysis was the patient pain score, converted to a standard 10-point intensity scale.

Secondary outcomes were patient-reported global assessments and adverse effects.

Compared with codeine, NSAIDs were associated with better pain scores at 6 hours (0.93 points mean difference) and at 12 hours (0.79 points mean difference).

The investigators noted even stronger NSAID superiority at 6 hours among the trials where acetaminophen was co-administered at equivalent doses between groups (1.18 points mean difference).

NSAIDs were associated with better global assessments at 6 hours and at 24 hours. And they were associated with fewer adverse effects, including bleeding.

The authors concluded, “We found that adult outpatients report better pain scores, better global assessments and fewer adverse effects when their postoperative pain is treated with NSAIDs than with codeine. Clinicians across all specialties can use this information to improve both pain management and opioid stewardship.”