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Lapi F, Marconi E, Aprile PL, Rossi A, Fornasari D, Cricelli C. Effectiveness of paracetamol-NSAID combinations for upper and lower respiratory tract infections: a preliminary evaluation in primary care. Eur J Clin Pharmacol 2024; 80:781-783. [PMID: 38367044 DOI: 10.1007/s00228-024-03651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Via del Sansovino 179, 50142, Florence, Italy.
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Via del Sansovino 179, 50142, Florence, Italy
| | | | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Diego Fornasari
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Janczura M, Kobus-Moryson M, Sip S, Żarowski M, Wareńczak A, Cielecka-Piontek J. Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain-A Practical Review. J Clin Med 2021; 10:jcm10143118. [PMID: 34300284 PMCID: PMC8306558 DOI: 10.3390/jcm10143118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or additive effect of drugs, it is possible to obtain a significant therapeutic effect and faster action with the use of smaller doses of individual drugs. In addition, one active ingredient may counteract adverse reactions from the other. Another essential aspect of the use of FDCs is the improvement of medical adherence due to the reduction in the pill burden on patients. It is also possible to develop a fixed-dosed combination product de novo to address a new therapeutic claim and be protected by patents so that the manufacturer can obtain exclusive rights to sell a particular FDC or a formulation thereof. The proposed fixed-dose combinations should always be based on valid therapeutic principles and consider the combined safety profile of all active substances included in the medicinal product. This review aims to identify which combinations of NSAIDs and spasmolytics have been developed and tested and which combinations are still under development.
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Affiliation(s)
- Magdalena Janczura
- Synteza sp. z o.o., św. Michała 67/71, 61-005 Poznań, Poland; (M.J.); (M.K.-M.)
- Department of Pharmacognosy, Faculty of Pharmacy, Poznań University of Medical Sciences, Święcickiego 4, 60-780 Poznań, Poland;
| | | | - Szymon Sip
- Department of Pharmacognosy, Faculty of Pharmacy, Poznań University of Medical Sciences, Święcickiego 4, 60-780 Poznań, Poland;
| | - Marcin Żarowski
- Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewski 49 Str., 60-355 Poznań, Poland;
| | - Agnieszka Wareńczak
- Clinic for Rehabilitation, Poznan University of Medical Sciences, 28 Czerwca 1956r. nr 135/147 Street, 61-545 Poznań, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Faculty of Pharmacy, Poznań University of Medical Sciences, Święcickiego 4, 60-780 Poznań, Poland;
- Correspondence:
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Issa LM, Thybo KH, Hägi-Pedersen D, Wetterslev J, Jakobsen JC, Overgaard S, Mathiesen O. Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment. Scand J Pain 2021; 21:384-392. [PMID: 34387964 DOI: 10.1515/sjpain-2020-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In this sub-study of the 'Paracetamol and Ibuprofen in Combination' (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants' pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain. METHODS We calculated the proportions of participants with mild (VAS 0-30 mm), moderate (VAS 31-60 mm) or severe (VAS 61-100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from -200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics. RESULTS Among 556 participants from the modified intention-to-treat population, 33% (95% CI: 26-42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21-37) (Group Paracetamol (PCM)), 23% (95% CI: 17-31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13-27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: -48% (IQR: -112 to 31), Group PCM: 40% (IQR: -31 to 97), Group IBU: -5% (IQR: -57 to 67), and Group HS-PCM + IBU: 6% (IQR: -70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29-0.82, weak opioid 0.56, 95% CI: 0.28-1.16, reference no analgesics before surgery, p=0.02). CONCLUSIONS Only one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.
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Affiliation(s)
- Luma Mahmoud Issa
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Kasper Højgaard Thybo
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Daniel Hägi-Pedersen
- Department of Anaesthesiology, Head of Research, Næstved, Slagelse and Ringsted Hospitals, Næstved, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Janus Christian Jakobsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Copenhagen Trial Unit, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Orthopaedic Research Unit, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Mathiesen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Thybo KH, Hägi‐Pedersen D, Wetterslev J, Overgaard S, Mathiesen O. The PANSAID randomized clinical trial: A pre-planned 1-year follow-up regarding harm. Acta Anaesthesiol Scand 2020; 64:910-912. [PMID: 32270482 DOI: 10.1111/aas.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/14/2020] [Accepted: 03/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limiting harm from postoperative pain treatment is important. However, long-term follow-up from acute pain trials are rare. The aim of the study was to provide long-term follow-up data regarding harm from the "Paracetamol and Ibuprofen in Combination" (PANSAID) trial. METHODS In this preplanned long-term follow-up study from the PANSAID trial, we used data from Danish national health registries (the Danish National Patient Registry and the Danish Civil Registration System) in addition to the 90-day follow-up in the original trial. The primary outcome was 1-year proportion of patients with one or more serious adverse events. RESULTS One-year follow-up was complete for 551 patients (99%). We found three additional patients with one or more serious adverse events in the 1-year follow-up compared with the 90-day follow-up. The relative risk of having one or more serious adverse event when randomized to ibuprofen compared with paracetamol was 1.40 (95% CI: 0.84-2.33, P = .20). CONCLUSION We found no statistically significant difference in 1-year serious adverse events between patients randomized to ibuprofen compared with paracetamol in patients having planned primary total hip arthroplasty. There were few additional events from the 90-day follow-up to the 1-year follow-up.
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Affiliation(s)
- Kasper H. Thybo
- Centre for Anaesthesiological Research Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Daniel Hägi‐Pedersen
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit Centre for Clinical Intervention Research Dpt. 7812 Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology Orthopedic Research Unit Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research Department of Anaesthesiology Zealand University Hospital Køge Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
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Thybo KH, Hägi‐Pedersen D, Wetterslev J, Dahl JB, Jakobsen JC, Pedersen NA, Jakobsen K, Bülow HH, Ibsen L, Overgaard S, Mathiesen O. Benefits and harm of paracetamol and ibuprofen in combination for post-operative pain: Pre-planned subgroup analyses of the multicenter, randomized PANSAID trial. Acta Anaesthesiol Scand 2020; 64:245-253. [PMID: 31648374 DOI: 10.1111/aas.13496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The "Paracetamol and Ibuprofen in Combination" (PANSAID) trial showed that combining paracetamol and ibuprofen resulted in lower opioid consumption than each drug alone and we did not find an increase in risk of harm when using ibuprofen vs paracetamol. The aim of this subgroup analysis was to investigate the differences in benefits and harms of the interventions in different subgroups. We hypothesized that the intervention effects would differ in subgroups with different risk of pain or adverse events. METHODS In these pre-planned subgroup analyses of the PANSAID trial population, we assessed subgroup heterogeneity in intervention effects between (a) subgroups (sex, age, use of analgesics, American Society of Anesthesiologists (ASA) score, and type of anesthesia) and morphine consumption, and (b) subgroups (sex, age, use of non-steroidal anti-inflammatory drugs (NSAIDs), and ASA score) and serious adverse events. RESULTS Test of interaction between age and the pairwise comparison between paracetamol 1 g vs paracetamol 0.5 g + ibuprofen 200 mg (P = .009) suggested lower morphine consumption in patients >65 years. However, post hoc analyses of related outcomes showed no interaction for this pairwise comparison. All other tests of interaction regarding both benefit and harm were not statistically significant. CONCLUSION These pre-planned subgroup analyses did not suggest that patients in the investigated subgroups benefitted differently from a basic non-opioid analgesic regimen consisting of paracetamol and ibuprofen. Further, there was no evidence of subgroup heterogeneity regarding harm and use of ibuprofen. Because of reduced statistical power in subgroup analyses, we cannot exclude clinically relevant subgroup heterogeneity.
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Affiliation(s)
- Kasper H. Thybo
- Department of Anesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
- Department of Anesthesiology Zealand University Hospital Køge Køge Denmark
| | - Daniel Hägi‐Pedersen
- Department of Anesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit Centre for Clinical Intervention Research Dpt. 7812 Copenhagen University Hospital Copenhagen Denmark
| | - Jørgen B. Dahl
- Department of Anesthesiology Bispebjerg and Frederiksberg Hospitals Copenhagen Denmark
| | - Janus C. Jakobsen
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
- Copenhagen Trial Unit Centre for Clinical Intervention Research Dpt. 7812 Copenhagen University Hospital Copenhagen Denmark
- Department of Internal Medicine Holbæk Hospital Holbæk Denmark
| | | | - Karina Jakobsen
- Department of Anesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Hans Henrik Bülow
- Department of Anesthesiology and Intensive Care Holbæk Hospital Holbæk Denmark
| | - Louise Ibsen
- Department of Orthopedic Surgery Holbæk Hospital Holbæk Denmark
| | - Søren Overgaard
- Orthopedic Research Unit Department of Orthopedic Surgery and Traumatology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Ole Mathiesen
- Department of Anesthesiology Zealand University Hospital Køge Køge Denmark
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Rugytė D, Gudaitytė J. Intravenous Paracetamol in Adjunct to Intravenous Ketoprofen for Postoperative Pain in Children Undergoing General Surgery: A Double-Blinded Randomized Study. ACTA ACUST UNITED AC 2019; 55:medicina55040086. [PMID: 30939851 PMCID: PMC6524359 DOI: 10.3390/medicina55040086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/28/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
Background and objectives: The combination of non-steroidal anti-inflammatory drugs and paracetamol is widely used for pediatric postoperative pain management, although the evidence of superiority of a combination over either drug alone is insufficient. We aimed to find out if intravenous (i.v.) paracetamol in a dose of 60 mg kg-1 24 h-¹, given in addition to i.v. ketoprofen (4.5 mg kg-1 24 h-¹), improves analgesia, physical recovery, and satisfaction with postoperative well-being in children and adolescents following moderate and major general surgery. Materials and Methods: Fifty-four patients were randomized to receive either i.v. paracetamol or normal saline as a placebo in adjunct to i.v. ketoprofen. For rescue analgesia in patients after moderate surgery, i.v. tramadol (2 mg kg-¹ up two doses in 24 h), and for children after major surgery, i.v. morphine-patient-controlled analgesia (PCA) were available. The main outcome measure was the amount of opioid consumed during the first 24 h after surgery. Pain level at 1 and over 24 h, time until the resumption of normal oral fluid intake, spontaneous urination after surgery, and satisfaction with postoperative well-being were also assessed. Results: Fifty-one patients (26 in the placebo group and 25 in the paracetamol group) were studied. There was no difference in required rescue tramadol doses (n = 11 in each group) or 24-h morphine consumption (mean difference (95% CI): 0.06 (⁻0.17; 0.29) or pain scores between placebo and paracetamol groups. In patients given morphine-PCA, time to normal fluid intake was faster in the paracetamol than the placebo subgroup: median difference (95% CI): 7.5 (1.3; 13.7) h, p = 0.02. Parental satisfaction score was higher in the paracetamol than the placebo group (mean difference: ⁻1.3 (⁻2.5; ⁻0.06), p = 0.04). Conclusions: There were no obvious benefits to opioid requirement or analgesia of adding regular intravenous paracetamol to intravenous ketoprofen in used doses. However, intravenous paracetamol may contribute to faster recovery of normal functions and higher satisfaction with postoperative well-being.
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MESH Headings
- Acetaminophen/administration & dosage
- Acetaminophen/adverse effects
- Administration, Intravenous
- Adolescent
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/adverse effects
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Child
- Child, Preschool
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Humans
- Infant
- Ketoprofen/administration & dosage
- Male
- Morphine/administration & dosage
- Morphine/therapeutic use
- Pain, Postoperative/drug therapy
- Patient Satisfaction
- Statistics, Nonparametric
- Tramadol/administration & dosage
- Tramadol/therapeutic use
- Treatment Outcome
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Affiliation(s)
- Danguolė Rugytė
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307Kaunas, Lithuania.
| | - Jūratė Gudaitytė
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307Kaunas, Lithuania.
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Thybo KH, Hägi-Pedersen D, Dahl JB, Wetterslev J, Nersesjan M, Jakobsen JC, Pedersen NA, Overgaard S, Schrøder HM, Schmidt H, Bjørck JG, Skovmand K, Frederiksen R, Buus-Nielsen M, Sørensen CV, Kruuse LS, Lindholm P, Mathiesen O. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. JAMA 2019; 321:562-571. [PMID: 30747964 PMCID: PMC6439592 DOI: 10.1001/jama.2018.22039] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Multimodal postoperative analgesia is widely used but lacks evidence of benefit. OBJECTIVE Investigate beneficial and harmful effects of 4 nonopioid analgesics regimens. DESIGN, SETTING, AND PARTICIPANTS Randomized, blinded, placebo-controlled, 4-group trial in 6 Danish hospitals with 90-day follow-up that included 556 patients undergoing total hip arthroplasty (THA) from December 2015 to October 2017. Final date of follow-up was January 1, 2018. INTERVENTIONS Participants were randomized to receive paracetamol (acetaminophen) 1000 mg plus ibuprofen 400 mg (n = 136; PCM + IBU), paracetamol 1000 mg plus matched placebo (n = 142; PCM), ibuprofen 400 mg plus matched placebo (n = 141; IBU), or half-strength paracetamol 500 mg plus ibuprofen 200 mg (n = 140; HS-PCM + IBU) orally every 6 hours for 24 hours postoperatively, starting 1 hour before surgery. MAIN OUTCOMES AND MEASURES Two co-primary outcomes: 24-hour morphine consumption using patient-controlled analgesia in pairwise comparisons between the 4 groups (multiplicity-adjusted thresholds for statistical significance, P < .0042; minimal clinically important difference, 10 mg), and proportion of patients with 1 or more serious adverse events (SAEs) within 90 days (multiplicity-adjusted thresholds for statistical significance, P < .025). RESULTS Among 559 randomized participants (mean age, 67 years; 277 [50%] women), 556 (99.5%) completed the trial and were included in the analysis. Median 24-hour morphine consumption was 20 mg (99.6% CI, 0-148) in the PCM + IBU group, 36 mg (99.6% CI, 0-166) for PCM alone, 26 mg (99.6% CI, 2-139) for IBU alone, and 28 mg (99.6% CI, 2-145) for HS-PCM + IBU. The median difference in morphine consumption between the PCM + IBU group vs PCM alone was 16 mg (99.6% CI, 6.5 to 24; P < .001); for the PCM-alone group vs HS-PCM + IBU, 8 mg (99.6% CI, -1 to 14; P = .001); and for the PCM + IBU group vs IBU alone, 6 mg (99.6% CI, -2 to 16; P = .002). The difference in morphine consumption was not statistically significant for the PCM + IBU group vs HS-PCM + IBU (8 mg [99.6% CI, -2 to 16]; P = .005) or for the PCM-alone group vs IBU alone (10 mg [99.6% CI, -2 to 16]; P = .004) after adjustment for multiple comparisons and 2 co-primary outcomes. There was no significant difference between the IBU-alone group vs HS-PCM + IBU (2 mg [99.6% CI, -10 to 7]; P = .81). The proportion of patients with SAEs in groups receiving IBU was 15%, and in the PCM-alone group, was 11%. The relative risk of SAE was 1.44 (97.5% CI, 0.79 to 2.64; P = .18). CONCLUSIONS AND RELEVANCE Among patients undergoing THA, paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone in the first 24 hours after surgery; there was no statistically significant increase in SAEs in the pooled groups receiving ibuprofen alone vs with paracetamol alone. However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02571361.
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Affiliation(s)
| | | | - Jørgen Berg Dahl
- Department of Anesthesiology, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mariam Nersesjan
- Department of Anesthesiology, Næstved Hospital, Næstved, Denmark
- Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | | | - Søren Overgaard
- Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Harald Schmidt
- Department of Orthopedic Surgery, Næstved Hospital, Næstved, Denmark
| | | | - Kamilla Skovmand
- Department of Anesthesiology, Nykøbing Falster Hospital, Nykøbing, Denmark
| | | | | | | | | | - Peter Lindholm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Ole Mathiesen
- Centre of Anaesthesiological Research, Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Thybo KH, Jakobsen JC, Hägi-Pedersen D, Pedersen NA, Dahl JB, Schrøder HM, Bülow HH, Bjørck JG, Overgaard S, Mathiesen O, Wetterslev J. PANSAID-PAracetamol and NSAID in combination: detailed statistical analysis plan for a randomised, blinded, parallel, four-group multicentre clinical trial. Trials 2017; 18:465. [PMID: 29017585 PMCID: PMC5634901 DOI: 10.1186/s13063-017-2203-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/16/2017] [Indexed: 01/02/2023] Open
Abstract
Background Effective postoperative pain management is essential for the rehabilitation of the surgical patient. The PANSAID trial evaluates the analgesic effects and safety of the combination of paracetamol and ibuprofen. This paper describes in detail the statistical analysis plan for the primary publication to prevent outcome reporting bias and data-driven analysis results. Methods/design The PANSAID trial is a multicentre, randomised, controlled, parallel, four-group clinical trial comparing the beneficial and harmful effects of different doses and combinations of paracetamol and ibuprofen in patients having total hip arthroplastic surgery. Patients, caregivers, physicians, investigators, and statisticians are blinded to the intervention. The two co-primary outcomes are 24-h consumption of morphine and proportion of patients with one or more serious adverse events within 90 days after surgery. Secondary outcomes are pain scores during mobilisation and at rest at 6 and 24 h postoperatively, and the proportion of patients with one or more adverse events within 24 h postoperatively. Discussion PANSAID will provide a large trial with low risk of bias regarding benefits and harms of the combination of paracetamol and ibuprofen used in a perioperative setting. Trial registration ClinicalTrials.org identifier: NCT02571361. Registered on 7 October 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2203-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kasper Højgaard Thybo
- Department of Anaesthesiology, Næstved Hospital, Ringstedgade 61, 4700, Næstved, Denmark.
| | | | - Daniel Hägi-Pedersen
- Department of Anaesthesiology, Næstved Hospital, Ringstedgade 61, 4700, Næstved, Denmark
| | - Niels Anker Pedersen
- Department of Anaesthesiology, Gildhøj Privathospital, Brøndbyvester Blvd. 16, 2605, Brøndby, Denmark
| | - Jørgen Berg Dahl
- Department of Anaesthesiology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | | | - Hans Henrik Bülow
- Department of Anaesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark
| | - Jan Gottfrid Bjørck
- Department of Ortopedic Surgergy, Nykøbing Falster Hospital, Fjordvej 15, 4800, Nykøbing Falster, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
| | - Ole Mathiesen
- Centre of Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Rigshospitalet, Dept. 7812, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
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