Comparison of Zomepirac, APC with Codeine, Codeine and Placebo in the Treatment of Moderate and Severe Postoperative Pain

Baird, Walter M.; Turek, Radovan

doi:10.1002/j.1552-4604.1980.tb01704.x

Cited by 39 publications

(5 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All included studies were both randomised and double blind. Six studies had a score of 3 using the Oxford Quality Scale (Bentley 1987; Defoort 1983; Honig 1984; Jain 1988; Sunshine 1988,van Steenberghe 1986), 9 a score of 4 (Baird 1980; Bloomfield 1981; Cooper 1982; Desjardins 1984; Giglio 1990; Hersh 1993;Mehlisch 1984; Sunshine 1987; Yonkeura 1987), and 20 a score of 5 (Forbes 1986; Hebertson 1986; Moore 1997 (17 studies);Sunshine 1983). Points were mainly lost due to inadequate description of the methods of randomisation and double blinding.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-three studies (2411 participants) provided data (Baird 1980; Bentley 1987; Bloomfield 1981; Cooper 1982; Defoort 1983; Desjardins 1984; Forbes 1986; Giglio 1990; Hebertson 1986; Hersh 1993; Honig 1984; Jain 1988; Moore 1997 (17 studies); Sunshine 1983; Sunshine 1987; Sunshine 1988; Yonkeura 1987). One study (van Steenberghe 1986) did not provide data for this outcome.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Single dose oral codeine, as a single agent, for acute postoperative pain in adults

Derry

Moore

McQuay

2010

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Codeine is an opioid metabolised to active analgesic compounds, including morphine. It is widely available by prescription, and combination drugs including low doses of codeine are commonly available without prescription. Objectives To assess the efficacy, the time to onset of analgesia, the time to use of rescue medication and any associated adverse events of single dose oral codeine in acute postoperative pain. Search methods We searched CENTRAL, MEDLINE, EMBASE and PubMed to November 2009. Selection criteria Single oral dose, randomised, double-blind, placebo-controlled trials of codeine for relief of established moderate to severe postoperative pain in adults. Data collection and analysis Studies were assessed for methodological quality and data independently extracted by two review authors. Summed total pain relief (TOTPAR) or pain intensity difference (SPID) over 4 to 6 hours were used to calculate the number of participants achieving at least 50% pain relief, which were used to calculate, with 95% confidence intervals, the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over 4 to 6 hours. Numbers using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Data on adverse events and withdrawals were collected. Main results Thirty-five studies were included (1223 participants received codeine 60 mg, 27 codeine 90 mg, and 1252 placebo). Combining all types of surgery (33 studies, 2411 participants), codeine 60 mg had an NNT of at least 50% pain relief over 4 to 6 hours of 12 (8.4 to 18) compared with placebo. At least 50% pain relief was achieved by 26% on codeine 60 mg and 17% on placebo. Following dental surgery the NNT was 21 (12 to 96) (15 studies, 1146 participants), and following other types of surgery the NNT was 6.8 (4.6 to 13) (18 studies, 1265 participants). The NNT to prevent use of rescue medication within 4 to 6 hours was 11 (6.3 to 50) (11 studies, 765 participants, mostly non-dental); the mean time to its use was 2.7 hours with codeine and 2.0 hours with placebo. More participants experienced adverse events with codeine 60 mg than placebo; the difference was not significant and none were serious. Two adverse event withdrawals occurred with placebo. Authors’ conclusions Single dose codeine 60 mg provides good analgesia to few individuals, and does not compare favourably with commonly used alternatives such as paracetamol, NSAIDs and their combinations with codeine, especially after dental surgery; the large difference between dental and other surgery was unexpected. Higher doses were not evaluated.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Single dose oral codeine, as a single agent, for acute postoperative pain in adults

Derry

Moore

McQuay

2010

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

“…1 In recent years, however, compounds belonging to this new generation of analgesics have been shown to be more effective than the aspirin 2 -s or acetamino-phen7· 8 standards usually employed by analgesiologists and equal to the analgesic efficacy of narcoticcontaining combination products. 5 · 7 - 10 Diflunisal (DOLOBlD®, Merck Sharp & Dohme) is the most recently marketed nonsteroidal antiinflam-38S matory analgesic. It is a difluorophenyl derivative of salicylic acid 11 (Figure 1) that produces less occult gastrointestinal blood loss 12 • 13 and less interference with platelet function 13 • 14 than aspirin.…”

mentioning

confidence: 99%

A 12‐Hour Evaluation of the Analgesic Efficacy of Diflunisal, Zomepirac Sodium, Aspirin, and Placebo in Postoperative Oral Surgery Pain

Forbes

Butterworth²,

Burchfield³

et al. 1983

Pharmacotherapy

View full text Add to dashboard Cite

One hundred ninety-nine outpatients with pain following oral surgery were randomly assigned, on a double-blind basis, a single oral dose of diflunisal (500 or 1,000 mg), zomepirac sodium 100 mg, aspirin 650 mg, or placebo. Using a self-rating record, subjects rated their pain and its relief hourly for 12 hours after medication. Measures of total and peak analgesia were derived from these patients' subjective reports. Diflunisal (500 and 1,000 mg) and zomepirac were significantly superior to aspirin and placebo for every measure of total and peak analgesia. Based upon the first 4 hours of observation, aspirin was superior to placebo for every measure of analgesia. Diflunisal 500 and 1,000 mg were comparable to zomepirac in peak analgesia and significantly superior to zomepirac for all measures of total analgesia. The onset of analgesia was comparable for 1,000 mg diflunisal, zomepirac, and aspirin, but more rapid for these treatments than for 500 mg diflunisal. The duration of analgesia was 12 hours for diflunisal, 9 hours for zomepirac, and 3 hours for aspirin.

show abstract

“…equal to that of subcutaneously administered morphine and superior to that of aspirin and codeine in the acetylcholine writhing test, but it is not effective in the Haffner and hot plate tests in mice which readily detect codeine. In clinical trials, zomepirac sodium has been reported to produce a potent analgesic activity that is equipotent to or superior to that of aspirin and narcotic analgesics such as morphine, pentazocine and APC (aspirin, phenacetin and caffeine) plus codeine (2)(3)(4)(5)(6). Zomepirac sodium, however, has been shown to be a potent inhibitor of prostaglandin synthetase, approx.…”

mentioning

confidence: 99%

Site of analgesic action of zomepirac sodium, a potent non-narcotic analgesic in experimental animals.

et al. 1983

View full text Add to dashboard Cite

Abstract-Zomepirac sodium inhibited the reflex hypertension caused by an injection of bradykinin into the splenic artery of anaesthetized dogs, but not that by injection of bradykinin plus PGE1. In the rat acetic acid writhing test, the potency ratio of intra peritoneal (ED50=0.41 itg/kg) to intravenous (ED50=33.5 ,ug/kg) anti-writhing activity of zomepirac sodium was 79.2 (37.1-173), though the ratio of codeine phosphate (373 ,ug/kg, i.p., 352 ig/kg, i.v.) was 0.934. When equipotent doses of zomepirac sodium were administered to rats receiving intraperitoneally acetic acid, the plasma zomepirac level after i.v. administration was more than 200 times that after i.p. adminis tration, while the peritoneal exudate zomepirac contents were nearly equal after adminis tration by both routes. Zomepirac sodium (5 ug/kg) did not produce significant anti writhing activity after intracerebroventricular administration. From these results, it was suggested that zomepirac sodium produced analgesic action through a strong blockade of the hyperalgesia in the peripheral system.

show abstract

Comparison of Zomepirac, APC with Codeine, Codeine and Placebo in the Treatment of Moderate and Severe Postoperative Pain

Cited by 39 publications

References 6 publications

Single dose oral codeine, as a single agent, for acute postoperative pain in adults

Single dose oral codeine, as a single agent, for acute postoperative pain in adults

A 12‐Hour Evaluation of the Analgesic Efficacy of Diflunisal, Zomepirac Sodium, Aspirin, and Placebo in Postoperative Oral Surgery Pain

Site of analgesic action of zomepirac sodium, a potent non-narcotic analgesic in experimental animals.

Contact Info

Product

Resources

About