A Cochrane review included 7 studies with a total of 2 241 subjects. The aim of the review was to compare the beneficial and harmful effects of paracetamol, ibuprofen and combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth, at different doses and administered postoperatively. Ibuprofen was found to be a superior analgesic to paracetamol at several doses. Results are shown in table for the most frequently assessed dose: ibuprofen 400 mg compared with paracetamol 1000 mg.
| Outcome | Relative effect (95% CI) | Assumed risk (paracetamol) | Corresponding risk (ibuprofen) | Participants (studies) |
|---|---|---|---|---|
| Proportion of patients with > 50% maximum pain relief over 6 hours | RR 1.47 (1.28 to 1.69) | 56 per 100 | 83 per 100 (72 to 95) | 646 (5 studies) |
| Proportion of patients with > 50% maximum pain relief over 2 hours | RR 1.30 (1.09 to 1.55) | 62 per 100 | 81 per 100 (68 to 97) | 645 (5 studies) |
| Number of patients not using rescue medication at 6 hours | RR 1.50 (1.25 to 1.79) | 50 per 100 | 75 per 100 (63 to 90) | 542 (4 studies) |
The combined drug paracetamol and ibuprofen showed promising results compared to single drugs (table ). The information available regarding adverse events from the studies (including nausea, vomiting, headaches and dizziness) indicated that they were comparable between the treatment groups.
| Outcome | Relative effect (95% CI) | Assumed risk (single drug) | Corresponding risk (combined ibuprofen and paracetamol) | Participants (studies) |
|---|---|---|---|---|
| *Combined ibuprofen 400 mg and paracetamol 1000 mg versus single drugs (paracetamol 1000 mg or ibuprofen 400 mg) ** Combined ibuprofen 400 mg/200 mg and paracetamol 1000 mg /500 mg versus single drugs | ||||
| Proportion of patients with > 50% maximum pain relief over 6 hours* | RR 1.77 (1.32 to 2.39) | 38 per 100 | 67 per 100 (50 to 91) | 170 (1 study) |
| Proportion of patients with > 50% maximum pain relief over 2 hours* | RR 1.29 (0.91 to 1.85) | 37 per 100 | 48 per 100 (34 to 68) | 170 (1 study) |
| Number of patients not using rescue medication at 8 hours** | RR 1.60 (1.36 to 1.88) | 50 per 100 | 80 per 100 (68 to 94) | 467 (2 studies) |
A Cochrane review included 21 studies with a total of 2 048 subjects. Paracetamol provided a statistically significant benefit when compared with placebo for pain relief and pain intensity at both 4 and 6 hours. Risk ratio values for pain relief at 4 hours 2.85 (95% confidence interval [CI] 1.89 to 4.29), and at 6 hours 3.32 (95% CI 1.88 to 5.87). A statistically significant benefit was also found between up to 1000 mg and 1000 mg doses, the higher the dose giving greater benefit for each measure at both time points. There was no statistically significant difference between the number of patients who reported adverse events, overall this being 19% in the paracetamol group and 16% in the placebo group.