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Systematic review and meta-analysis
Limited evidence that single-dose oral ibuprofen plus codeine is more effective for postoperative pain than either drug alone
  1. Jaime L Baratta,
  2. Kishor Gandhi,
  3. Eugene R Viscusi
  1. Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to: Dr Eugene R Viscusi, Department of Anesthesiology, Thomas Jefferson University, 111 S 11th Street, Suite G-8490, Philadelphia, PA 19107, USA; eugene.viscusi{at}

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Implications for practice and research

  • Professional societies (American Society of Anesthesiology (ASA) and the European Society of Anaesthesiology (ESA)) recommend maximising non-opioid over opioid analgesics and utilising a multimodal approach to perioperative pain management.

  • This systematic review (SR) examines the effects of combining codeine and ibuprofen.

  • The authors of SR conclude that ibuprofen and codeine combinations may provide enhanced efficacy.

  • Future research should focus on whether combination agents provide better analgesia than their individual constituent alone.


Postoperative pain control remains challenging. Historically, there has been a reliance on opioids for pain management. The American Society of Anesthesiology's (ASA's) most recent guidelines recommend maximising non-opioid agents with around-the-clock dosing and using opioids supplementally.1 Derry and colleagues performed a meticulous SR examining the analgesic efficacy of single-dose ibuprofen and codeine …

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