Use of Paracetamol and Ibuprofen in Combination for Pain Relief in Children after Oral Surgery

Abstract

The aim of this study was to determine the use of paracetamol and ibuprofen in combination for pain relief in children after oral surgery. Children under 10 years old having one or more wisdom teeth removed under general or local anaesthesia were instructed to take two tablets before the operation then, every 4 h for up to 48 h, two tablets of a combination of acetaminophen 250 mg and ibuprofen 150 mg per tablet and acetaminophen 250 mg per tablet alone and ibuprofen 150 mg per tablet alone. The primary outcome measure was the area under the curve of the 100 mm visual analogue scale of pain measurements taken for up to 36 h after surgery, divided by time, at rest and in activity. The result showed that although all four secondary endpoints favoured the combination treatment, only the global pain rating reached statistical significance. More participants experienced ‘nil’ or ‘mild’ pain with the combination (68.4%) than with either other group; this difference was significant for acetaminophen (37.5%; P=0.008), but not for ibuprofen (54.3%; P=0.263). The use of any rescue medication also favoured the combination treatment, but this did not reach statistical significance. In conclusion, we demonstrated that patients using the combination of acetaminophen and ibuprofen experienced less pain during the first 48 h after oral surgery than those using the same daily dosage of either agent alone and we think the difference was clinically relevant.