Summary of findings 1. Intravenous diclofenac compared to placebo for acute postoperative pain in adults.
| Intravenous diclofenac (37.5 mg to 75 mg) compared to placebo for acute postoperative pain in adults | ||||||
| Patient or population: Adults (mean study ages 25 to 55 years) with acute postoperative pain after dental, mixed minor, abdominal, or orthopedic surgeries Settings: Hospital or community Intervention: Intravenous diclofenac (37.5 mg to 75 mg) Comparison: Placebo | ||||||
| Outcomes | Probable outcome with | Relative effect and NNTB or NNTH (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Placebo | Diclofenac | |||||
| Number of participants with at least 50% pain relief at 4 hours | 228 per 1000 | 643 per 1000 (458 to 905) |
RR 2.8 (2.0 to 4.0) NNTB 2.4 (1.9 to 3.1) |
277 (3 studies) | ⊕⊕⊝⊝ low1,2,3,4 | |
| Number of participants with at least 50% pain relief at 6 hours | 336 per 1000 | 592 per 1000 (478 to 730) |
RR 1.8 (1.4 to 2.2) NNTB 3.8 (2.9 to 5.9) |
436 (4 studies) | ⊕⊕⊝⊝ low1,2 | |
| Median (or mean) time to use of rescue medication | Median: 80 minutes | Median: 226 minutes | Not applicable | 542 (5 studies) |
⊕⊕⊝⊝ low1,5 | |
| Number of participants using rescue medication over 4 to 6 hours postinterventions | 810 per 1000 | 478 per 1000 (389 to 592) |
RR 0.59 (0.48 to 0.73) NNTp3.0 (2.2 to 4.5) |
235 (2 studies) | ⊕⊕⊝⊝ low1,3 | |
| Number of participants reporting any adverse event | 709 per 1000 | 702 per 1000 (610 to 809) | RR 0.99 (0.86 to 1.1) | 296 (2 studies) | ⊕⊕⊝⊝ low1,3 | |
| Number of participants experiencing a serious adverse event | 4 per 1000 | 4 per 1000 (1 to 31) | RR 1.0 (0.15 to 7.02) | 472 (5 studies) | ⊕⊕⊝⊝ low1,6 | Studies underpowered to detect these events. |
| CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; NNTp: number needed to treat to prevent one event; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Unclear risk of bias in several domains. 2Unexplained heterogeneity. 3Total number of participants < 400. 4Large magnitude of effect: RR > 2. 5Imprecision: unable to estimate confidence intervals due to reporting of median data. 6Very low number of events.