Evaluation of Ketorolac, Ibuprofen, Acetaminophen, and an Acetaminophen‐Codeine Combination in Postoperative Oral Surgery Pain

Abstract

Two‐hundred six outpatients with postoperative pain after the surgical removal of impacted third molars were randomly assigned on a double‐blind basis to receive oral doses of ketorolac tromethamine 10 and 20 mg, ibuprofen 400 mg, acetaminophen 600 mg, a combination of acetaminophen 600 mg plus codeine 60 mg, or placebo. Using a self‐rating record, subjects rated their pain and its relief hourly for 6 hours after medicating. All active medications were significantly superior to placebo. Analgesia was similar for ketorolac 10 and 20 mg and ibuprofen 400 mg; however, these treatments were superior to acetaminophen alone and the acetaminophen‐codeine combination. The analgesic effect of each active medication was significant by hour 1 and persisted for 5–6 hours. The data suggest a plateau in ketorolac's analgesic efficacy at the 10‐mg level. Repeat‐dose data indicated that on the day of surgery ketorolac 10 and 20 mg and ibuprofen 400 mg were superior to acetaminophen 600 mg; ketorolac 20 mg was also superior to acetaminophen‐codeine. Differences among active medications were not significant when data for the entire postoperative period (days 0–6) were evaluated. The frequency of adverse effects was similar for the active medications.