Clinical bottom line
Based on somewhat limited information, a combination of paracetamol plus tramadol is an effective analgesic in acute postoperative pain. The NNT compared with placebo over six hours was about 2.7.
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The combination of tramadol with paracetamol is not commonly available for prescription, but has recently (2002) become available in the USA. The exact dosage strengths in the combinations may vary from country to country, so affecting its efficacy.
SYSTEMATIC REVIEW
JE Edwards et al. Combination analgesic efficacy: Individual patient data meta-analysis of single dose oral tramadol plus acetaminophen in acute postoperative pain. Journal of Pain and Symptom Management 2002 23:121-30.
” Date review completed: 2001
” Number of trials included: 7
” Number of patients: various, because different combination strengths
” Control group: oral placebo
” Main outcomes: pain relief at 6 hours (TOTPAR), Number-needed-to-treat (NNT) (with 95% confidence intervals) and relative benefit (with 95% confidence intervals). Duration of analgesia through time to remedication.
Inclusion criteria were single oral dose, randomised, placebo-controlled, double-blind trials of paracetamol plus tramadol in acute postoperative pain with sufficient data to calculate the area under the curve for pain relief (TOTPAR). Baseline pain was moderate to severe. The six and eight hour TOTPAR was calculated for each patient (this was an individual patient analysis), and the data were converted to the percent of maximum total pain relief from categorical pain scales (%maxTOTPAR), and then to dichotomous information to generate a number-needed-to-treat for at least 50% pain relief. Relative benefit was calculated to provide an assessment of how much more likely an individual given a particular treatment is to have at least 50% pain relief than someone given no treatment. Adverse effects frequency data were used to calculate numbers-needed-to-harm and relative risk.
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