BACKGROUND: Cesarean section, episiotomy, and third and perineal tears are associated with significant tissue damage, causing pain in the immediate postpartum period. The current standard in North America is to prescribe oral acetaminophen/codeine (A + C) for postpartum pain. Codeine has opioid-related adverse effects and may not be safe during breastfeeding in the postpartum period for all neonates. Nonsteroidal anti-inflammatory drugs (NSAIDs) are devoid of opioid-related adverse effects and could be a possible alternative for analgesia in postpartum pain. The objective of this systematic review was to compare the analgesic effect and safety profile of acetaminophen/codeine (A + C) with NSAIDs in the management of pain after laparotomy. METHODS: A systematic search was performed by using MEDLINE, EMBASE, CINAHL, and Cochrane Library databases to identify randomized controlled trials comparing A + C to NSAIDs for postlaparotomy pain. Selected articles were critically appraised by using the CONSORT method and Jadad score. RESULTS: Nine relevant articles were identified. All 9 studies used a visual analog scale for pain intensity and reported the incidence of adverse effects as an outcome. None of the studies showed lower pain intensity scores after treatment with A + C compared with different NSAIDs. In 3 studies, the number of patients with adverse effects was significantly lower in the NSAID group compared with the A + C-group. In 1 other study, the rate of constipation was significantly lower in the NSAID group when compared with the A + C-group. The other 5 studies did not report any significant differences in the rates of adverse effects between the 2 groups. CONCLUSIONS: None of the studies found A + C to be superior to NSAIDs in controlling postlaparotomy pain. NSAIDs appear to be an equipotent alternative in the treatment of postlaparotomy pain. Four of the 9 studies reported less adverse effects in the NSAID group. There appears to be an overall better risk/benefit ratio for the use of NSAIDs for postpartum pain.
BACKGROUND: Cesarean section, episiotomy, and third and perineal tears are associated with significant tissue damage, causing pain in the immediate postpartum period. The current standard in North America is to prescribe oral acetaminophen/codeine (A + C) for postpartum pain. Codeine has opioid-related adverse effects and may not be safe during breastfeeding in the postpartum period for all neonates. Nonsteroidal anti-inflammatory drugs (NSAIDs) are devoid of opioid-related adverse effects and could be a possible alternative for analgesia in postpartum pain. The objective of this systematic review was to compare the analgesic effect and safety profile of acetaminophen/codeine (A + C) with NSAIDs in the management of pain after laparotomy. METHODS: A systematic search was performed by using MEDLINE, EMBASE, CINAHL, and Cochrane Library databases to identify randomized controlled trials comparing A + C to NSAIDs for postlaparotomy pain. Selected articles were critically appraised by using the CONSORT method and Jadad score. RESULTS: Nine relevant articles were identified. All 9 studies used a visual analog scale for pain intensity and reported the incidence of adverse effects as an outcome. None of the studies showed lower pain intensity scores after treatment with A + C compared with different NSAIDs. In 3 studies, the number of patients with adverse effects was significantly lower in the NSAID group compared with the A + C-group. In 1 other study, the rate of constipation was significantly lower in the NSAID group when compared with the A + C-group. The other 5 studies did not report any significant differences in the rates of adverse effects between the 2 groups. CONCLUSIONS: None of the studies found A + C to be superior to NSAIDs in controlling postlaparotomy pain. NSAIDs appear to be an equipotent alternative in the treatment of postlaparotomy pain. Four of the 9 studies reported less adverse effects in the NSAID group. There appears to be an overall better risk/benefit ratio for the use of NSAIDs for postpartum pain.
Authors: Kathleen S Romanowski; Joshua Carson; Kate Pape; Eileen Bernal; Sam Sharar; Shelley Wiechman; Damien Carter; Yuk Ming Liu; Stephanie Nitzschke; Paul Bhalla; Jeffrey Litt; Rene Przkora; Bruce Friedman; Stephanie Popiak; James Jeng; Colleen M Ryan; Victor Joe Journal: J Burn Care Res Date: 2020-11-30 Impact factor: 1.845
Authors: Omid Ahmadi; Amir Shirvani Dehkordi; Farhad Heydari; Mohammad Nasr Esfahani; Behzad Mahaki Journal: J Res Med Sci Date: 2018-02-20 Impact factor: 1.852
Authors: Giustino Varrassi; Eli Alon; Michela Bagnasco; Luigi Lanata; Victor Mayoral-Rojals; Antonella Paladini; Joseph V Pergolizzi; Serge Perrot; Carmelo Scarpignato; Thomas Tölle Journal: Adv Ther Date: 2019-08-16 Impact factor: 3.845
Authors: Lauren E Kelly; Shahnaz A Chaudhry; Michael J Rieder; Geert 't Jong; Myla E Moretti; Andrea Lausman; Colin Ross; Howard Berger; Bruce Carleton; Michael R Hayden; Parvaz Madadi; Gideon Koren Journal: PLoS One Date: 2013-07-29 Impact factor: 3.240
Authors: Dmitri Nepogodiev; Stephen J Chapman; James C D Glasbey; Michael Kelly; Chetan Khatri; J Edward Fitzgerald; Aneel Bhangu Journal: BMJ Open Date: 2014-06-27 Impact factor: 2.692