effectiveness of low-dose codeine combinations. No new adverse events were identified. Derry S, Karlin SM, Moore RA. Acute postoperative pain Area under the pain Single dose Updated Cochrane review The review sought evidence (2015) Single dose oral in adults relief versus time ibuprofen + codeine (original 2013) - date of according to the dose of ibuprofen plus codeine for curve. search 1 December 2014. codeine used (low< 10mg, vs acute postoperative pain in No new studies found. medium 10 to 20mg, and Proportion of patients adults. Cochrane Database of high >20mg). placebo with at least 50% pain Six studies with 1342 Systematic Reviews DOI: relief over six hours. participants The authors found no data or relating to low-dose codeine, RR and NNT. In four studies (443 limited data for medium the same dose of participants) using dose codeine and most of ibuprofen alone Proportion of ibuprofen 400 mg plus the data related to high dose participants requiring codeine 25.6 mg to 60 mg Low (<10mg), codeine (25.6 60mg – rescue medication (high dose codeine) 64% of medium (10-20mg) codeine). and weighted mean of participants had at least and high (>20mg) median time to use. 50% maximum pain relief One study compared doses of codeine with the combination ibuprofen 400mg + 20mg compared to 18% with codeine with same dose of placebo. The NNT was 2.2 ibuprofen alone (McQuay (95% confidence interval 1989) and 2 studies 1.8 to 2.6) (high quality compared ibuprofen 400mg evidence). + 60mg codeine with same dose of ibuprofen alone In three studies (204 (Cooper 1982 and Sunshine participants) ibuprofen 1987). For these three plus codeine (any dose) studies analysed together, was better than the same ibuprofen plus codeine was dose of ibuprofen (69% better than ibuprofen alone, versus 55%) but the result but the difference only just was barely significant with reached statistical a relative benefit of 1.3 significance (relative benefit 1.3 (1.01 to 1.6)) and the McQuay study (medium
effectiveness of low-dose codeine combinations. No new adverse events were identified. Derry S, Karlin SM, Moore RA. (2015) Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database of Systematic Reviews DOI: Acute postoperative pain in adults Area under the pain relief versus time curve. Proportion of patients with at least 50% pain relief over six hours. RR and NNT. Proportion of participants requiring rescue medication and weighted mean of median time to use. Single dose ibuprofen + codeine vs placebo or the same dose of ibuprofen alone Low (<10mg), medium (10-20mg) and high (>20mg) doses of codeine Updated Cochrane review (original 2013) - date of search 1 December 2014. No new studies found. Six studies with 1342 participants In four studies (443 participants) using ibuprofen 400 mg plus codeine 25.6 mg to 60 mg (high dose codeine) 64% of participants had at least 50% maximum pain relief with the combination compared to 18% with placebo. The NNT was 2.2 (95% confidence interval 1.8 to 2.6) (high quality evidence). In three studies (204 participants) ibuprofen plus codeine (any dose) was better than the same dose of ibuprofen (69% versus 55%) but the result was barely significant with a relative benefit of 1.3 The review sought evidence according to the dose of codeine used (low< 10mg, medium 10 to 20mg, and high >20mg). The authors found no data relating to low-dose codeine, limited data for medium dose codeine and most of the data related to high dose codeine (25.6 – 60mg codeine). One study compared ibuprofen 400mg + 20mg codeine with same dose of ibuprofen alone (McQuay 1989) and 2 studies compared ibuprofen 400mg + 60mg codeine with same dose of ibuprofen alone (Cooper 1982 and Sunshine 1987). For these three studies analysed together, ibuprofen plus codeine was better than ibuprofen alone, but the difference only just reached statistical significance (relative benefit 1.3 (1.01 to 1.6)) and the McQuay study (medium
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