Choi et al conducted a systematic review and meta-analysis of randomized, controlled trials comparing codeine and NSAIDs for postoperative pain in outpatient surgery. The researchers searched MEDLINE and Embase from inception to October 2019 for eligible studies. The primary outcome was the patient pain score, converted to a standard 10-point intensity scale, and the secondary outcomes were patient reported global assessments and adverse effects.

They also utilized random-effects models and grading of recommendations assessment, development, and evaluation (GRADE) to evaluate the quality of evidence. They found that 40 studies, including 102 trial arms and 5,116 patients, met inclusion criteria. The studies had low risk of bias and low-tomoderate heterogeneity. The researchers found that compared with codeine, NSAIDs were associated with better pain scores at 6 hours (weighted mean difference [WMD] 0.93 points; 95% confidence interval [CI], 0.71 to 1.15) and at 12 hours (WMD 0.79; 95% CI, 0.38 to-1.19).

Stronger NSAID superiority at 6 hours was detected among trials where acetaminophen was coadministered at equivalent doses between groups (WMD 1.18; 95% CI, 0.87 to 1.48). NSAIDs were associated with better global assessments at 6 hours (WMD −0.88; 95% CI, −1.04 to −0.72) and at 24 hours (WMD −0.67; 95% CI, −0.95 to −0.40), and were correlated with fewer adverse effects, including bleeding events. 

They concluded that the results from this meta-analysis found that patients randomized to NSAIDs following outpatient surgical procedures reported better pain scores, better global assessment scores, fewer adverse effects, and no difference in bleeding events compared with patients receiving codeine.

The researchers also noted that although these findings reinforce existing evidence and are widely generalizable to patients across surgical disciplines, further studies should evaluate the comparative effectiveness of other nonopioid analgesics, and studies should test these findings in other populations and settings.

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