tolfenamic-acid and Pain--Postoperative

This is an updated version of the original Cochrane review published in Issue 3, 2012. Caffeine has been added to common analgesics such as paracetamol, ibuprofen, and aspirin, in the belief that it enhances analgesic efficacy. Evidence to support this belief is limited and often based on invalid comparisons.. To assess the relative efficacy of a single dose of an analgesic plus caffeine against the same dose of the analgesic alone, without restriction on the analgesic used or the pain condition studied. We also assessed serious adverse events.. We searched CENTRAL, MEDLINE, and EMBASE from inception to 28 August 2014, the Oxford Pain Relief Database, and also carried out Internet searches and contacted pharmaceutical companies known to have carried out trials that have not been published.. We included randomised, double-blind studies that compared a single dose of analgesic plus caffeine with the same dose of the analgesic alone in the treatment of acute pain.. Two review authors independently assessed the eligibility and quality of studies, and extracted data. Any disagreements or uncertainties were settled by discussion with a third review author. We sought any validated measure of analgesic efficacy, but particularly the number of participants experiencing at least 50% of the maximum possible pain relief over four to six hours, participants reporting a global evaluation of treatment of very good or excellent, or headache relief after two hours. We pooled comparable data to look for a statistically significant difference, and calculated numbers needed to treat to benefit (NNT) with caffeine. We also looked for any numerical superiority associated with the addition of caffeine, and information about any serious adverse events.. We identified no new studies with available results for this update. The earlier review included 20 studies (7238 participants) in valid comparisons, but because we used different outcomes for some headache studies, the number of participants in the analyses of the effects of caffeine is now 4262 when previously it was 5243. The studies were generally of good methodological quality, using standard designs and mostly standard scales of pain measurement, although many of those treating postoperative pain were small.Most studies used paracetamol or ibuprofen, with 100 mg to 130 mg caffeine, and the most common pain conditions studied were postoperative dental pain, postpartum pain, and headache. There was a small but statistically significant benefit with caffeine used at doses of 100 mg or more, which was not dependent on the pain condition or type of analgesic. About 5% to 10% more participants achieve a good level of pain relief (at least 50% of the maximum over four to six hours) with the addition of caffeine, giving a NNT of about 14 (high quality evidence).Most comparisons individually demonstrated numerical superiority with caffeine, but not statistical superiority. One serious adverse event was reported with caffeine, but was considered unrelated to any study medication.We know of the existence of around 25 additional studies with almost 12,500 participants for which data for analysis were not obtainable. The additional analgesic effect of caffeine remained statistically significant but clinically less important even if all the known missing data had no effect; the bulk of the unobtainable data are reported to have similar results as this review.. The addition of caffeine (≥ 100 mg) to a standard dose of commonly used analgesics provides a small but important increase in the proportion of participants who experience a good level of pain relief.

Topics: Acetaminophen; Acute Pain; Adolescent; Adult; Aged; Analgesics; Caffeine; Chemotherapy, Adjuvant; Diclofenac; Drug Synergism; Dysmenorrhea; Female; Headache; Humans; Ibuprofen; Male; Middle Aged; ortho-Aminobenzoates; Pain, Postoperative; Postpartum Period; Pregnancy; Randomized Controlled Trials as Topic

To investigate the efficacy of meloxicam or tolfenamic acid administered preoperatively and postoperatively (five days in total) to cats undergoing surgical fracture repair.. Eighty-eight otherwise healthy cats were matched according to fracture site and then randomly allocated to one of two groups, receiving 0·2 mg/kg meloxicam by subcutaneous injection (group M) or 1·5 to 3 mg/kg tolfenamic acid orally (group T) before anaesthesia. Analgesia was continued with 0.05 mg/kg oral meloxicam once daily or 1·5 to 3 mg/kg oral tolfenamic acid twice daily for four days postoperatively. Pain was assessed by a blinded observer using visual analogue scales and a functional limb score. The drug administrator assessed feed intake and palatability of the treatment.. Data from 66 cats were analysed. Visual analogue scale pain scores and functional limb scores decreased over time in both groups but were not significantly different between treatments. Feed intake was similar in both groups. Meloxicam was significantly more palatable than tolfenamic acid on all treatment days.. Meloxicam and tolfenamic acid demonstrated comparable analgesia, without clinically observable side effects. Meloxicam may be associated with superior compliance in clinical practice due to the higher palatability and once daily treatment resulting in better ease of administration.

Topics: Analgesia; Analgesics; Animals; Cats; Female; Fractures, Bone; Lameness, Animal; Male; Meloxicam; ortho-Aminobenzoates; Pain Measurement; Pain, Postoperative; Postoperative Care; Thiazines; Thiazoles

The hypothesis was that Visual Analog Scale (VAS) scores would be lower, and mechanical wound thresholds (MWT) higher, in cats receiving tolfenamic acid compared to those receiving placebo in the postoperative period following elective ovariohysterectomy.. Sixty-nine client-owned cats.. A prospective, randomized, blinded and placebo-controlled study was performed in cats which underwent ovariohysterectomy following preoperative tolfenamic acid, meloxicam, or placebo. A second dose of the same analgesic was administered 24 hours postoperatively. Assessments were made 1-hour before induction and 1, 2, 4, 6, 22, and 25 hours postoperatively. Pain was assessed by a blinded observer using Numerical Rating (NRS) and VAS scales. The MWT were measured using a force-measuring device. Group comparison was performed by using one-way ANOVA and chi-squared test for qualitative and quantitative data, respectively, and a mixed model for repeated measurements (p < 0.05).. Sixty-five cats were included in the study. There were no differences between groups at baseline. There was a treatment effect on the NRS scores at 6, 22 and 25 hours. The meloxicam group was less painful than controls at 6 and 22 hours; both treatment groups were less painful than controls at 25 hours. There were no differences between groups in VAS for pain or sedation. The number of animals receiving rescue analgesia did not differ between groups. There was a treatment effect on MWT; thresholds in both treatment groups were significantly higher than that observed in controls at all time points.. Preoperative tolfenamic acid or meloxicam reduced wound sensitivity following ovariohysterectomy in the cat.. Tolfenamic acid and meloxicam administered preoperatively provided a similar analgesic effect in the postoperative period lasting 24 hours. Mechanical thresholds may be a better way of evaluating postoperative analgesia provided by nonsteroidal anti-inflammatory drugs in cats.

Topics: Analgesics; Animals; Cats; Female; Hysterectomy; Meloxicam; ortho-Aminobenzoates; Ovariectomy; Pain Measurement; Pain, Postoperative; Thiazines; Thiazoles

In this randomized, placebo-controlled, blinded field trial, 62 dogs (of which four were excluded) taken to a veterinary practice for orthopaedic surgery with a postoperative painful component were enrolled to assess the efficacy of a preoperative intramuscular injection of tolfenamic acid (TA) at a dose of 4 mg/kg in preventing postoperative pain. The animals were clinically examined at T1 + 1H, T1 + 4H, T1 + 24H (T1 = extubation). The efficacy results showed a statistical effect of TA in preventing postoperative pain with the evolution in the pain statistically in favour of TA treatment (Visual Analogue Scale). This was confirmed by the sum of the scores calculated at T1 + 24H that was statistically higher in the placebo group, and by the evolution in the respiratory rate, which was statistically lower in the TA-treated animals after surgery. TA treatment was very well tolerated as no clinical sign (except one isolated case of vomiting and diarrhoea, i.e. 3.5%) or change in biochemical and haematological values was observed and as no interaction with the anaesthetic drugs and with marbofloxacin was reported.

Topics: Analgesics; Anesthesia Recovery Period; Animals; Dogs; Female; Injections, Intramuscular; Male; ortho-Aminobenzoates; Pain Measurement; Pain, Postoperative; Treatment Outcome

The adequacy of postoperative analgesia was assessed in 40 cats following ovariohysterectomy. At extubation, cats were given one dose of carprofen, ketoprofen, meloxicam or tolfenamic acid. Postoperative analgesia was assessed using visual analogue scale (VAS) scoring for pain and sedation; measurement of mechanical nociceptive thresholds at the wound; recognition of the requirement for rescue intervention analgesia; and an overall clinical assessment score at 18 hours. VAS pain scores were low throughout the trial, with no significant differences found between the groups. Postoperative mechanical nociceptive thresholds decreased significantly from baseline in all four groups, with no significant differences between the groups. One cat in each of the tolfenamic acid, ketoprofen and meloxicam groups required rescue intervention analgesia. Nine out of 10 cats in all four groups were classified as having desirable overall clinical assessment scores. In summary, all four drugs provided good postoperative analgesia, although none was able to prevent postoperative wound tenderness.

Topics: Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Carbazoles; Cats; Female; Hysterectomy; Ketoprofen; Meloxicam; ortho-Aminobenzoates; Ovariectomy; Pain Measurement; Pain, Postoperative; Thiazines; Thiazoles; Treatment Outcome

The objective of this study was to evaluate the efficacy of a non-selective COX inhibitor (tolfenamic acid) and a selective COX-2 inhibitor (robenacoxib) for post-operative pain control in cats. Thirty cats undergoing ovariohysterectomy were randomly divided into three groups: the control (placebo) group, the tolfenamic acid (4 mg/kg/day) group, and the robenacoxib (1 mg/kg/day) group. Non-steroidal anti-inflammatory drugs (NSAIDs) were administered orally 2 hr before anesthesia induction and 24 and 48 hr post-operation. Buccal mucosal bleeding times (BMBTs) were assessed prior to anesthesia induction. Colorado pain scores and composite pain scores were evaluated in a blinded fashion before induction and 2, 8, 24, 30 and 48 hr post-operation. The Colorado pain scores of cats receiving robenacoxib were significantly lower than those of cats in the control group at 30 (P=0.0126) and 48 (P=0.0439) hr post-operation. The composite pain scores of cats from the robenacoxib group were lower than those of cats in the control group at 30 (P=0.0299) and 48 (P=0.0103) hr post-operation. The Colorado pain scores of cats receiving tolfenamic acid were significantly lower than those of cats in the control group at 30 hr (P=0.0186) post-operation. The composite pain scores in cats in the tolfenamic acid group were lower than the scores of cats in the control group at 24 (P=0.0403) and 48 (P=0.0413) hr post-operation. BMBTs remained within normal limits in all groups. Both tolfenamic acid and robenacoxib are useful for post-operative pain control in cats.

Topics: Analgesia; Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Cats; Diphenylamine; Female; Hysterectomy; ortho-Aminobenzoates; Ovariectomy; Pain Measurement; Pain, Postoperative; Phenylacetates

The current practice of postoperative pain management among Finnish oral surgeons was evaluated in a two-phase study. In the first phase, a questionnaire was sent to specialist members of the Finnish Society of Oral and Maxillofacial Surgeons that concerned the routine use of analgesic drugs after surgical removal of third molar teeth. In the second phase, the clinical adequacy of pain medication was assessed in 84 patients who had the same procedure. Patients estimated the intensity of pain with a 100 mm visual analogue scale at five time points during the day of surgery and on three postoperative days. Anti-inflammatory analgesics were widely used either alone or in combination with centrally acting analgesic drugs. Tolfenamic acid, diclofenac, and ketoprofen were the most commonly used analgesic drugs. The analgesic effect of the currently used drug combinations proved to be sufficient except in a few patients during the first night after surgery.

Topics: Adult; Analgesics; Analysis of Variance; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Drug Combinations; Drug Therapy, Combination; Female; Finland; Humans; Ketoprofen; Male; Molar, Third; ortho-Aminobenzoates; Pain Measurement; Pain, Postoperative; Tooth Extraction; Tooth, Impacted