Effect of Ketoprofen and Dexketoprofen in the management of acute postoperative pain

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Effect of Ketoprofen and Dexketoprofen in the management of acute postoperative pain

Patients undergoing surgical procedures experience acute or sometimes chronic postoperative pain.  This pain can be managed through certain pain relief medicines such as Ketoprofen and Dexketoprofen. Both these drugs are analgesic non-selective nonsteroidal anti-inflammatory drugs (NSAIDs). Theoretically, Dexketoprofen at half the dose as compared to Ketoprofen imparts equivalent analgesic effect with lower gastrointestinal adverse events. This review was executed to evaluate individual reviews brought together in two overviews to provide information about the relative efficacy and harm of various interventions.

The techniques that allow comparison with other analgesics and the criteria of efficacy according to an in-depth study at the individual patient level evaluated the efficacy and safety of single-dose oral Ketoprofen and Dexketoprofen as compared with placebo for acute postoperative pain.

Gaskell H et al. investigated the data from CENTRAL, Embase and MEDLINE articles published from 2009 to 28-March-2017. Reference lists of retrieved studies, reviews and two online clinical trial registries were also explored.

This randomized, double-blind, placebo-controlled trial was investigated by two review authors independently who considered studies for inclusion in the review, examined the problems of study quality and potential bias, and extracted data. The risk ratio (RR) and number needed to treat for other profitable outcome (NNT) and harmful outcome (NNH) for Ketoprofen and Dexketoprofen were noted for dichotomous outcomes. The data on the number of participants with at least 50% of the maximum possible pain relief over 6 hours, the median time to use of rescue medication, and proportion of participants who needed rescue medication was gathered. The information on adverse events and withdrawals were also collected. The quality of evidence was determined by GRADE and then the 'Summary of findings' tables was designed.

A total of 1001 participants (with 70% women) from six additional studies along with 24 studies were involved in the comparisons of Ketoprofen or Dexketoprofen and placebo, with a 12% and 65% increase in participants taking Ketoprofen and Dexketoprofen were comprised in this review. Young participants (mean age 20-30 years) were considered in dental studies and older participants (mean age 37-68 years) in other types of surgery. Further, high risk of bias was examined for small size that can lead to overestimation of benefit.

Ketoprofen doses varied from 6.5 mg to 150 mg. The proportion of participants attaining at least 50% pain relief over 6 hours with the usual oral Ketoprofen dose (50 mg) was 57% as compared to 23% with placebo, with an NNT of 2.9. Dental studies had significantly better efficacy (NNT 1.8) than other surgery (NNT 4.2). The ratio of participants using rescue medication within 6 hours was lower with Ketoprofen (32%) than with placebo (75%), allowing a number needed to treat to prevent the use of rescue medication (NNTp) of 2.3. The median time to remedication assessment was poorly expressed. The adverse events were almost similar with Ketoprofen (18%) and placebo (11). No serious adverse events were reported. Dexketoprofen doses varied from 5 mg to 100 mg. The proportion of participants achieving at least 50% pain relief over 6 hours with the usual oral Dexketoprofen dose (20 mg or 25 mg) was 52% as compared to 27% with placebo, with an NNT of 4.1. Dental studies had significantly better efficacy (NNT 2.7) than other surgery (NNT 5.7). The ratio of participants using rescue medication within 6 hours was lower with Dexketoprofen (47%) than with placebo (69%), giving an NNTp of 4.7. The median time to remedication assessment was poorly expressed. No serious effect was noticed in any group.

Therefore, Ketoprofen 25 mg to 100 mg shows an effective analgesic effect with an NNT of 2.9 for at least 50% pain relief with 50 mg dose for moderate to severe acute postoperative pain. The most frequently used NSAIDs like as Ibuprofen (NNT 2.5 for 400 mg dose) and Diclofenac (NNT 2.7 for 50 mg dose) also display similar analgesic effect. Dexketoprofen 10 mg to 25 mg is effective with an NNT of 4.1. Unusual differential efficacy was observed between dental surgery and other types of surgery for both the drugs. Also, the single doses of both Ketoprofen and Dexketoprofen were well tolerated.

Source:

Cochrane Database Syst Rev. 2017 May 25;5:CD007355

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/28540716

Original title of the article:

Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults

Authors:

Gaskell H et al.

SearchTags: 
Therapeutic, Ketoprofen, Dexketoprofen, Postoperative pain, Dental, Acute, NSAIDs, Analgesic, Randomized double-blind placebo-controlled trial, Efficacy, Safety, Tolerability, Risk ratio (RR), NNT, NNH, GRADE, Gastrointestinal, Oral
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