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Benefits and harm of paracetamol and ibuprofen in combination for postoperative pain: Pre-planned subgroup analyses of the multicenter, randomized PANSAID trial

Acta Anaesthesiologica Scandinavica Jan 30, 2020

Thybo KH, Hägi-Pedersen D, Wetterslev J, et al. - Given that lower opioid consumption resulting from combining paracetamol and ibuprofen vs each drug alone has been shown in the “Paracetamol and Ibuprofen in Combination” (PANSAID) trial and no rise in the risk of harm was noted when using ibuprofen vs paracetamol, researchers performed this subgroup analysis to determine the disparities in benefits and harms of the interventions in distinct subgroups. They hypothesized different effects of the intervention among subgroups with different risk of pain or adverse events. They evaluated subgroup heterogeneity in intervention impacts between subgroups (gender, age, use of analgesics, American Society of Anesthesiologists (ASA) score, and type of anesthesia) and morphine use, and subgroups (gender, age, use of non-steroidal anti-inflammatory drugs, and ASA score) and serious adverse events in these pre-planned subgroup studies of the PANSAID trial populace. Findings did not reveal any different benefits of a basic non-opioid analgesic regimen consisting of paracetamol and ibuprofen among patients in the investigated subgroups. No proof of subgroup heterogeneity concerning harm and the use of ibuprofen was found. Clinically relevant subgroup heterogeneity could not be excluded due to reduced statistical power in subgroup analyses.
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