Cochrane · intervention · CD004487
Paracetamol for pain relief after surgical removal of lower wisdom teeth
Weil, K, Hooper, L, Afzal, Z, et al. · Cochrane Database of Systematic Reviews · 2007 · Cochrane Library
Oral HealthPain control and patient managementOral and maxillofacial surgery2 versionsAMSTAR 2: not assessed
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
5
current version
GRADE rated
0
No studies
0
Included studies
21
as reported
No studies 0 · 0%Ungraded 5 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local anaesthesia, intravenous sedation, or general anaesthesia; patients taking concurrent analgesia excluded) | Patients requiring surgical removal of a lower wisdom tooth with baseline moderate to severe pain (n=1968 analysed, 2048 enrolled; 21 RCTs) |
| Intervention | Paracetamol given as a single dose by mouth in any dose and formulation (immediate or slow release) for efficacy; paracetamol given up to 7 days by mouth for the assessment of side effects | Paracetamol, single oral dose (up to 1000 mg, n=11 studies; 1000 mg, n=11 studies; Seymour 1996 used both doses) |
| Comparison | Placebo | Placebo (n=21 studies) |
| Outcomes | Pain intensity (VAS, categorical verbal rating, verbal numerical scale, global subjective efficacy ratings and other categorical rating scales); Pain relief (VAS/categorical scales; derived total pain relief (TOTPAR) and summed pain intensity difference (SPID); proportion achieving at least 50% pain relief over four to six hours); Side effects (e.g. hepatic and renal) (binary) | At least 50% pain relief at 4 hours using pain relief measures (n=16 studies); at least 50% pain relief at 6 hours using pain relief measures (n=13 studies); at least 50% pain relief at 4 hours using pain intensity measures (n=17 studies); at least 50% pain relief at 6 hours using pain intensity measures (n=13 studies); patients with adverse events (n=17 studies) |
| Study designs | All randomised controlled double blind clinical trials | RCT (randomised, parallel-group, double-blind) (n=21 studies) |
| Timing | Single-dose efficacy assessed at 4 and 6 hours; side effects up to 7 days | 4 hours; 6 hours (single dose) |
Search date: 2006-08. Databases: The Cochrane Oral Health Group's Trials Register (to 24 August 2006); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 3); The Cochrane Pain, Palliative and Supportive Care Group's Trials Register (to 24 August 2006); MEDLINE (1966 to 24 August 2006);…
Questions and results
Current version onlyParacetamol (single oral dose, any dose or formulation; subgroups up to 1000 mg and 1000 mg or more) vs Placebo
Population: Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local anaesthesia, intravenous sedation, or general anaesthesia; patients taking concurrent analgesia excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Achieving at least 50% pain relief at 4 hours (using pain intensity measurements / SPID) 4 hours | RR 4.87 [2.83, 8.37] | 17 studies · 1658 participants | Ungraded |
Achieving at least 50% pain relief at 6 hours (using pain intensity measurements / SPID) 6 hours | RR 3.41 [2.34, 4.97] | 13 studies · 1184 participants | Ungraded |
Patients with one or more adverse events up to 7 days | RR 1.19 [0.90, 1.57] | 17 studies · 1645 participants | Ungraded |
Achieving at least 50% pain relief at 6 hours (using pain relief measurements / TOTPAR) 6 hours | RR 3.32 [1.88, 5.87] | 13 studies · 1155 participants | Ungraded |
Achieving at least 50% pain relief at 4 hours (using pain relief measurements / TOTPAR) 4 hours | RR 2.85 [1.89, 4.29] | 16 studies · 1498 participants | Ungraded |
Paracetamol (oral, any dose or formulation; single dose for efficacy, up to 7 days for side effects) vs Placebo
Population: Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local anaesthesia, intravenous sedation, or general anaesthesia; patients taking concurrent analgesia excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Achieving at least 50% pain relief at 4 hours (using pain relief measurements / TOTPAR) 4 hours | no estimate extracted | NR | No studies |
Achieving at least 50% pain relief at 6 hours (using pain relief measurements / TOTPAR) 6 hours | no estimate extracted | NR | No studies |
Patients with one or more adverse events up to 7 days | no estimate extracted | NR | No studies |
Achieving at least 50% pain relief at 6 hours (using pain intensity measurements / SPID) 6 hours | no estimate extracted | NR | No studies |
Achieving at least 50% pain relief at 4 hours (using pain intensity measurements / SPID) 4 hours | no estimate extracted | NR | No studies |