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Acute Pain | Chronic Pain | General

Dextropropoxyphene in postoperative pain

Clinical bottom line:

65 mg of dextropropoxyphene is not an effective analgesic for oral single dose use.


Dextropropoxyphene is a relatively weak opioid analgesic which has been widely available since the 1950s. It is used alone and in combination with paracetamol or aspirin.

Systematic review

Collins SL, Edwards JE, Moore RA, McQuay HJ Single dose dextropropoxyphene in postoperative pain: a quantitative systematic review. European Journal of Clinical Pharmacology 1998; 54:107-112.

Inclusion criteria were full journal publication, single oral dose, randomised, placebo-controlled, double-blind trials of dextropropoxyphene in acute postoperative pain, baseline pain moderate to severe. Mean TOTPAR and SPID values for each trial were converted to %maxTOTPAR and %maxSPID, and then the proportion of patients achieving at least 50%maxTOTPAR were calculated. This information was used to calculate the NNT and relative. Adverse effects frequency data were used to calculate numbers-needed-to-harm and relative risk.

Findings

Six reports compared dextropropoxyphene hydrochloride 65 mg with placebo, and one trial also compared a dose of 130 mg with placebo.

A single oral dose of dextropropoxyphene 65 mg was no better than placebo for pain of moderate to severe intensity – relative benefit 1.5 (1.2 to 1.9). The NNT was 7.7(4.6 to 22).

Adverse effects

No patient withdrew as a result of adverse effects, and all reported were transient and of mild to moderate severity. Overall, at doses of 65 mg there was no significant difference in adverse effects with dextropropoxyphene compared with placebo.

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