Analgesic efficacy of ibuprofen alone and in combination with codeine or caffeine in post-surgical pain: a meta-analysis

Objective: To estimate the analgesic effect of ibuprofen and to test whether codeine and caffeine enhance its effect on post-surgical pain. Method: Systematic overview of the literature and meta-analysis of published randomised, controlled trials. Results: Ibuprofen is effective in dental pain, episiotomy pain and other post-operative pain. There is a dose–response relationship over the range 50–400 mg. The difference in total pain-relief score relative to placebo was 19–31%. On average, patients were over three times more likely to obtain moderate to excellent pain relief with ibuprofen than with placebo (response-rate ratio = 3.45) and the number needed to treat was 2.44. Codeine 60 mg enhanced the analgesic effect of ibuprofen 400 mg by about 8% in the total pain-relief scale, but it also increased its adverse effects. The additive effect of caffeine was inconsistent. Conclusion: Ibuprofen is an effective analgesic in postoperative pain. Codeine 60 mg adds to the analgesic effect of ibuprofen 400 mg. Any additive caffeine effect requires validation. Received: 5 February 1997 / Accepted in revised form: 11 August 1997