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

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Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults
Key Take-Away: 

Acute postoperative pain management had become the critical component that needs to be immediately addressed after various kinds of surgery. This review unfolds the effects of ketoprofen or dexketoprofen and concludes that ketoprofen or dexketoprofen are well tolerated and efficacious analgesics in the management of postoperative pain.

This review is an update of "Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults".

ABSTRACT: 
Background: 

This review is an update of "Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults". Ketoprofen is a non-selective nonsteroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions.

Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically, dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. This review is one of a series of oral analgesics for acute postoperative pain. Individual reviews have been brought together in two overviews to provide information about the relative efficacy and harm of the different interventions.

Methods: 

Literature was searched in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from 2009 to 28 March 2017. Also, the reference lists of retrieved studies and reviews and two online clinical trial registries were searched.

Randomized, double-blind, placebo-controlled trials of single dose orally administered ketoprofen or dexketoprofen in adults with moderate to severe acute postoperative pain were included in the study. Two review authors independently considered studies for inclusion in the review examined issues of study quality and potential bias and extracted data. For dichotomous outcomes, risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH) with 95% confidence intervals (CI) for ketoprofen and dexketoprofen, compared with placebo, was calculated. We collected information on the number of participants with at least 50% of the maximum possible pain relief over six hours, the median time to use of rescue medication, and the proportion of participants requiring rescue medication. Information on adverse events and withdrawals was also collected and the quality of the evidence using GRADE. 

Results: 

A total of 24 studies were included; six additional studies added 1001 participants involved in comparisons of ketoprofen or dexketoprofen and placebo, with a 12% increase in participants taking ketoprofen and a 65% increase for dexketoprofen.

Most participants (70%) were women. Dental studies typically involved young participants (mean age 20 to 30 years); other types of surgery involved older participants (mean age 37 to 68 years). Overall, studies at high risk of bias only for small size, which can lead to an overestimation of benefit were assessed. Ketoprofen doses ranged between 6.5 mg and 150 mg. The proportion of participants achieving at least 50% pain relief over six hours with the usual ketoprofen oral dose of 50 mg was 57%, compared to 23% with placebo, giving an NNT of 2.9 (95% CI 2.4 to 3.7) (RR 2.5, 95% CI 2.0 to 3.1; 594 participants; 8 studies; high quality evidence). Efficacy was significantly better in dental studies (NNT 1.8) than other surgery (NNT 4.2). The proportion of participants using rescue medication within six hours was lower with ketoprofen (32%) than with placebo (75%), giving a number needed to treat to prevent use of rescue medication (NNTp) of 2.3 (95% CI 1.8 to 3.1); 263 participants; 4 studies; high quality evidence). Median time to remedication estimates was poorly reported. Reports of any adverse event were similar with ketoprofen (18%) and placebo (11%) (RR 1.6, 95% CI 0.98 to 2.8; 342 participants; 5 studies; high-quality evidence). No study reported any serious adverse events. Dexketoprofen doses ranged between 5 mg and 100 mg. The proportion of participants achieving at least 50% pain relief over six hours with the usual dexketoprofen oral dose of 20 mg or 25 mg was 52%, compared to 27% with placebo, giving an NNT of 4.1 (95% CI 3.3 to 5.2) (RR 2.0, 95% CI 1.6 to 2.2; 1177 participants; 8 studies; high quality evidence). Efficacy was significantly better in dental studies (NNT 2.7) than other surgery (NNT 5.7). The proportion of participants using rescue medication within six hours was lower with dexketoprofen (47%) than placebo (69%), giving an NNTp of 4.7 (95% CI 3.3 to 8.0); 445 participants; 5 studies; high-quality evidence). Median time to remedication estimates was poorly reported. Reports of any adverse event were similar with dexketoprofen (14%) and placebo (10%) (RR 1.4, 95% CI 0.89 to 2.2; 536 participants, six studies; high-quality evidence). No study reported any serious adverse events.

Conclusion: 

Ketoprofen at doses of 25 mg to 100 mg is an effective analgesic in moderate to severe acute postoperative pain with NNT for at least 50% pain relief of 2.9 with a 50 mg dose. This is similar to that of commonly used NSAIDs such as ibuprofen (NNT 2.5 for 400 mg dose) and diclofenac (NNT 2.7 for 50 mg dose).

Dexketoprofen is also effective with NNT of 4.1 in the dose range 10 mg to 25 mg. Differential efficacy of dental surgery and other types of surgery seen for both drugs is unusual. Both drugs were well tolerated in single doses.

Source:

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

Link to the source:

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

The original title of the article:

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

Authors:

Gaskell H et al.

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