The efficacy of codeine when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: a double-blind randomised control trial

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adrian D. Best, R.K. De Silva, W.M. Thomson, Darryl C. Tong, Claire M. Cameron, Harsha L. De Silva
BackgroundThe use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol/ibuprofen/codeine. We assessed the efficacy of codeine when added to a paracetamol/ibuprofen regimen for pain relief following third molar surgery.MethodsThis study was a randomised, double-blind, placebo-controlled trial conducted in patients undergoing the surgical removal of at least one impacted mandibular third molar requiring bone removal. Participants were randomly allocated to either a control group (paracetamol 1000mg/ibuprofen 400mg) or an intervention group (paracetamol 1000mg/ibuprofen 400mg/codeine 60mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using visual analogue scales every 3 hours (while awake) for the first 48 hours following surgery. Pain was globally assessed using a questionnaire on day 3 after surgery.ResultsThere were 131 participants (36% male), with 67 in the control group and 64 in the intervention group. Baseline characteristics were similar for both groups. Data were analysed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with the subsequent VAS scores and that, with each 3hr period, the VAS score increased by an average of 0.08. The treatment effect was not statistically significant, indicating there was no difference in recorded pain levels between the two groups over the first 48 hours following mandibular third molar surgery. Similarly, the two groups did not differ in their global ratings of postoperative pain.ConclusionCodeine 60mg added to a paracetamol 1000mg/ibuprofen 400mg regimen does not improve analgesia following third molar surgery.



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