Ibuprofen 300mg modified-release / Codeine 20mg tablets

Introduction: Venous ulceration (VU) is a chronic lower limb wound caused by sustained venous hypertension. Treatment includes compression therapy, wound care and surgical intervention. Due to the prolonged nature of wound healing, patients experience a substantial burden on quality of life, largely influenced by pain. Existing literature generalises findings across all chronic wounds and there are no published reviews or specific guidelines informing pharmacological pain management for patients with VU. Methods: Five databases were searched to identify studies evaluating the effectiveness of pharmacological interventions for VU pain, published in English between 2000 and 2024. The CASP appraisal tools were used to assess the quality of publications, and findings are reporting descriptively and following PRISMA guidance. Results: Initial literature searches yielded 1,161 references, of which 447 were duplicates. Once screening was complete, thirteen studies were included in this evaluation. The majority (10/13) were randomised controlled trials comparing pharmacological interventions with standard care. Small sample sizes and poor reporting quality were common across all papers, and overall limits the evidence. Eight studies evaluated ibuprofen-impregnated dressings, all reporting some degree of pain reduction. Three studies investigated localized oxygen therapy, demonstrating improved wound healing outcomes. However, pain reduction was not statistically significant and may be secondary to healing. The remaining two studies examined topical sevoflurane and aspirin. Sevoflurane showed pain reduction over time in a single, low-quality retrospective study. The aspirin trial was inconclusive due to poor recruitment and underpowering. Conclusion: Currently, there is a lack of high-quality studies, evaluating the pharmacological treatment of pain in people experiencing VU. While there may be some evidence to support the use of topical agents such as ibuprofen, further industry-independent efficacy studies and cost analyses are required. Further research is also required to compare standard of care to commonly used agents such as oral paracetamol.

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Post-endodontic pain is a common complication that negatively impacts patients’ daily lives. Single-dose oral analgesics are often prescribed after non-surgical root canal treatments to manage discomfort; however, their relative efficacy remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of different single-dose postoperative medications for pain relief following root canal treatment (RCT). A comprehensive search of PubMed, Scopus, Embase, and Cochrane CENTRAL up to February 2025 was conducted to identify randomized controlled trials (RCTs) comparing single-dose postoperative analgesics with placebo in patients undergoing non-surgical endodontic treatment. Pain outcomes were assessed using Visual Analog Scales (VAS) at 6–8, 12, and 24 h post-treatment. Risk of bias was evaluated using the Cochrane RoB 2 tool. Pairwise and frequentist network meta-analyses were performed, and treatments were ranked using P-scores. Ten RCTs were qualitatively analyzed, while five of them were eligible for quantitative analyses and were included in our meta-analysis. They were from four countries with a combined sample size of 347 participants. At 6–8 h, Diclofenac + Acetaminophen provided the greatest pain reduction (MD: -6.28, 95% CI: -11.99 to -0.56), followed by Novafen and Ibuprofen + Acetaminophen. At 12 and 24 h, Novafen and Naproxen consistently demonstrated superior analgesic effects, whereas Tramadol and Ibuprofen offered moderate relief. Ibuprofen combinations with Acetaminophen or Alprazolam showed variable efficacy. Sensitivity analyses confirmed the robustness of these findings. Single-dose oral medications administered after non-surgical root canal treatments effectively reduce post-endodontic pain. Diclofenac + Acetaminophen is most effective for immediate short-term relief, while Novafen and Naproxen provide sustained efficacy at later time points. These results can guide clinicians in selecting optimal single-dose medications for post-RCT pain management. Keywords: postoperative endodontic pain; network meta-analysis; pain management; endodontic treatment Not applicable.

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Formulating a tailored clinical practice guideline is imperative for each country, necessitated by the refined considerations of medication availability, accessibility, and affordability. Hence, in this study, we aimed to investigate the clinical practice guidelines regarding acute and postoperative dental pain and customize them in prescribing analgesics for Iranian general dentists. The study employed a two-phase approach; a qualitative customization of dental pain management guidelines and a cross-sectional analytic phase. The qualitative phase involved assembling a panel of specialists and adapting existing guidelines to create customized flowcharts, along with a review of literature regarding relative guidelines. In the cross-sectional analytic phase, two questionnaires (one for each flowchart) were designed to build a consensus-based final guideline for Iranian dentists. Participants provided insights through questionnaires, assessing relevance and clarity. The Scale content validity index (S-CVI) and item content validity index (I-CVI) were assessed, with a threshold of 0.79 considered acceptable. Our search initially identified 763 articles and guidelines. After screening, 36 studies provided recommended strategies for acute dental and post-operative pain management. According to these studies and the available regimens in Iran, pain management was outlined in two flowcharts, A and B, addressing mild, moderate and severe pain levels. The lowest Item-level content validity index (I-CVI) was 0.93 and all items showed acceptable agreement regarding content validity. Scale-level content validity index (S-CVI) values reached 0.99 for flowchart A and B., indicating strong consensus among experts. Also, since all items showed acceptable agreement and were above the threshold value, the S-CVI/UA for the relevance and clarity in both flowcharts A and B were 100% among all experts in our study. Acetaminophen and ibuprofen are the drug of choice for dental pain. For more intense dental and post-operative dental pains a combination of these two drugs or their combination with opioids is recommended. In Iran, the only available opioid is codeine 10–20 mg that is combined with acetaminophen 300–325 mg, which is prescribed for severe dental pains. Naproxen can also be an effective alternative to ibuprofen.

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Due to the invasive nature of craniotomy, effective postoperative pain management is essential in pediatric neurosurgical patients, yet standardized guidelines remain limited. This scoping review evaluated postoperative analgesic strategies in children undergoing craniotomy to identify effective approaches and assess opioid-sparing techniques. Twenty-four studies met inclusion criteria, including five case reports/series and nineteen retrospective or prospective investigations, comprising 1,567 patients with a mean reported age of 6.3 years. Opioids were the most frequently used analgesics (70.7%), most commonly morphine and codeine, while non-opioid regimens including NSAIDs/acetaminophen, sedatives, local anesthetic infiltration, and regional nerve blocks were used. Overall clinical improvement was reported in 61.7% of patients, with similar outcomes between single-agent and multimodal regimens. Randomized trials showed scheduled non-opioid therapy, nerve blocks, and local anesthetic techniques reduced pain scores and opioid requirements without increased complications. Current evidence supports multimodal, opioid-minimizing strategies with opioids reserved for breakthrough pain, although further studies are needed.

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BACKGROUND: The impact of bariatric surgery on the pharmacokinetics of codeine, oxycodone or tramadol is largely unknown. METHODS: In patients treated with these opioids before and after bariatric surgery, serial drug concentrations were measured throughout a dose interval preoperatively and 1, 6 and 12 months postoperatively. RESULTS: Eight patients treated with codeine (n = 2), oxycodone (n = 2) or tramadol (n = 4) were included. In the patients using codeine, the area under the concentration-time curve during a dose interval (AUC) was moderately increased for the active metabolites morphine and morphine 6-glucuronide 6-12 months after bariatric surgery. For oxycodone, there were only negligible AUC changes. In the tramadol group, there were no discernible AUC changes considered to be caused by the surgical procedure. There were no apparent changes in maximum concentrations or times to achieve maximum concentrations after surgery for any of the drugs or their metabolites. CONCLUSION: From a pharmacokinetic point of view, we found no evidence that particular follow-up procedures should be needed for codeine, oxycodone and tramadol in patients undergoing bariatric surgery and continuing drug treatment. However, as always, doses should be adjusted based on clinical effect and the occurrence of adverse drug reactions.

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Traditional Chinese medicine (TCM) production generates wastewater containing high level of morphine, codeine, and other opioids. Our field investigations at TCM factories revealed that existing activated sludge systems, though may be compliant for other chemicals, exhibit limited removal efficiency for these recalcitrant contaminants. Consecutive daily monitoring of effluent showed morphine persistently at concentrations ranging from 37,029–301,623 ng/L due to incomplete biodegradation, posing a significant disruption to aquatic environment and its further wastewater-based surveillance in public security. To address this challenge, we developed an advanced hydrodynamic cavitation-ozonation system (HC/O 3 ), incorporating a novel negative-pressure reactor configuration. Under optimized conditions (1.5 L/min ozone inflow, 4 mg/L ozone concentration), the system achieved 94% removal of morphine within one hour, with a synergy index of 1.46 demonstrating remarkable process enhancement. Distinct from prior laboratory-scale investigations limited to model pollutants, this work validated HC/O 3 performance treating six psychoactive substances in compositionally variable TCM wastewater, demonstrating scalability and robustness under real-world operating conditions. Over a 5-day continuous trial with variable influent compositions, the HC/O 3 system demonstrated robust adaptability, consistently achieving 99.9% removal of morphine and thebaine within 3 h, specifically at 94% removal for morphine-specific reduction within first hour. The operational costs of 5.38 USD/m 3 and energy efficiency reflected in a 1.11 × 10 -7 mg/J cavitational yield. This result indicates potential economic viability and technical robustness of this integrated solution for industrial implementation, under the tested conditions. The HC/O 3 process establishes a new approach for treating pharmaceutical-laden wastewater, simultaneously reducing environmental risks for aquatic ecosystems and potentially improving the reliability of wastewater-based surveillance

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