Tramadol 75mg / Paracetamol 650mg tablets

BackgroundInadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects.ObjectiveTo identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy.Databases and data treatmentThis systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE.ResultsA total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions-including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin-were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia.ConclusionsMultiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice.SignificanceThe findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. However, the high risk of bias and low quality of evidence in many of the included trials necessitate cautious interpretation of the findings.

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BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 TRIAL REGISTRATION: Not applicable.

Abstract licence: CC BY-NC-ND

BackgroundWe aimed to evaluate the efficacy and safety of early analgesic interventions, particularly NSAIDs versus opioids, in reducing pain and improving clinical outcomes among adults with AP.MethodsA systematic literature search was conducted across PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and ClinicalTrials.gov from database/registry inception to December 2025 to obtain relevant data. Randomized controlled trials involving adults aged 18 years or older diagnosed with AP, irrespective of the etiology and severity, who were administered analgesics (opioids, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, epidural anesthesia, local anesthesia, and paracetamol) and compared with placebo, conventional treatment, or another analgesic modality were included in this review. The primary outcome assessed was pain reduction. The secondary outcomes assessed were the need for rescue analgesia, length of hospital stay, complications (local and/or systemic), mortality, and adverse drug effects. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0. Effect estimates were pooled using a random-effects meta-analysis (DerSimonian-Laird approach), while nonpooled outcomes were summarized narratively.ResultsA total of 13 studies were included in the analysis. NSAIDs provided pain relief comparable to opioids, with a lower incidence of local complications (RR: 0.59, 95% CI: 0.37-0.94). No significant differences in the need for rescue analgesia (OR: 0.88, 95% CI: 0.33-2.35), length of hospital stay (MD: -2.68 d, 95% CI: -6.27 to 0.91), mortality (RR: 0.76, 95% CI: 0.19-3.05), and adverse drug effects (RR: 0.55, 95% CI: 0.17-1.76) were observed. However, the findings are limited by study bias and heterogeneity.ConclusionEarly analgesia with NSAIDs has efficacy and safety comparable to opioids in adults with AP, with the advantage of reducing local complications.

Abstract licence: CC BY-NC-ND