A Randomized Controlled Trial Comparing Acetaminophen, Acetaminophen and Ibuprofen, and Acetaminophen and Codeine for Postoperative Pain Relief After Mohs Surgery and Cutaneous Reconstruction

• Published in: Dermatologic surgery 2011-07, Vol.37 (7), p.1007-1013
• Main Authors: SNIEZEK, PATRICK J., BRODLAND, DAVID G., ZITELLI, JOHN A.
• Format: Article
• Language: English
• Subjects: Acetaminophen - therapeutic use; Age Factors; Aged; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Carcinoma, Basal Cell - surgery; Carcinoma, Squamous Cell - surgery; Codeine - therapeutic use; Dermatology; Double-Blind Method; Drug Therapy, Combination; Female; Head and Neck Neoplasms - surgery; Humans; Ibuprofen - therapeutic use; Male; Medical sciences; Melanoma - surgery; Middle Aged; Mohs Surgery - adverse effects; Pain Measurement; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Pharmacology. Drug treatments; Reconstructive Surgical Procedures - adverse effects; Skin Neoplasms - surgery; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.2011.02022.x

BACKGROUND There are no population‐based data comparing analgesics after Mohs micrographic surgery (MMS) and reconstruction. OBJECTIVE To compare the efficacy in pain management of three analgesic combinations. METHODS In a randomized, double‐blind, controlled study, patients undergoing MMS and reconstruction for head and neck skin cancers received 1,000 mg of acetaminophen (Ac), 1,000 mg Ac plus 400 mg ibuprofen (Ib), or 325 mg Ac plus 30 mg codeine (Co) immediately after surgery and every 4 hours for up to four doses. Patients rated their pain on a visual analog scale (VAS) 0, 2, 4, 8, and 12 hours after surgery and recorded medication‐related side effects. RESULTS The Ac+Ib group had the lowest pain scores (mean change from baseline/immeditely prior to surgery) at each postoperative recorded time interval and a significantly smaller change from baseline pain scores than the Ac+Co group at 4 hours (p=.005) and the Ac group at 8 hours (p=.02). Ac+Ib was also superior in pain control for patients with surgical areas smaller than 10 cm2. Complications in the Ib+Ac group were significantly lower than in the Ac+Co group but not the Ac group. CONCLUSIONS The combination of Ac+Ib is superior to Ac alone or Ac+Co in controlling postoperative pain after MMS and cutaneous reconstruction. The authors have indicated no significant interest with commercial supporters.