Lyngstad G, Skjelbred P, Swanson D M, Skoglund L A. Analgesic effect of oral ibuprofen 400, 600, and 800 mg; paracetamol 500 and 1000 mg; and paracetamol 1000 mg plus 60 mg codeine in acute postoperative pain: a single-dose, randomized, placebo-controlled, and double-blind study. Eur J Clin Pharmacol 2021; 77: 1843-1852.

Paracetamol 1,000/codeine 60 mg gave similar analgesia as ibuprofen from 400 mg.

Ibuprofen (400 mg, 600 mg, 800 mg), paracetamol (1,000 mg, 500 mg), paracetamol 1,000 mg/codeine 60 mg, and placebo were investigated to establish the multidimensional pharmacodynamic profiles. A randomised, double-blind, placebo-controlled study used 350 patients after third molar surgery. Primary outcome was sum pain intensity over six hours. Secondary outcomes were time to analgesic onset, duration of analgesia, time to rescue drug intake, number of patients taking rescue drug, sum pain intensity difference, maximum pain intensity difference, time to maximum pain intensity difference, number needed to treat, adverse effects, overall drug assessment as patient-reported outcome measure (PROM), and the effect size estimates NNT and NNTp. Ibuprofen doses above 400 mg do not significantly increase analgesic effect. Paracetamol has a very flat analgesic dose-response profile. Paracetamol 1,000/codeine 60 mg gave similar analgesia as ibuprofen from 400 mg but had a shorter time to analgesic onset. Active drugs show no significant difference in maximal analgesic effect. The frequencies of adverse effects were low, mild to moderate in all active groups. NNT and NTTp values did not coincide well with PROMs.