• H J McQuay, D Carroll, P G Guest, S Robson, P J Wiffen, and R P Juniper.
• Oxford Regional Pain Relief Unit, Churchill Hospital.
• Br J Oral Maxillofac Surg. 1993 Apr 1; 31 (2): 95-100.

AbstractThe objectives were to compare the relative merits of ibuprofen 400 mg and dihydrocodeine 30 mg or 60 mg taken up to four times daily for up to 6 days in the treatment of pain after third molar removal. A randomised, double-blind, multiple dose, crossover study was undertaken in 68 patients undergoing two-stage bilateral lower third molar removal. The results showed that ibuprofen produced significantly greater analgesia than either of the dihydrocodeine treatments on the day of surgery. Ibuprofen and dihydrocodeine 60 mg produced significantly greater analgesia than dihydrocodeine 30 mg on the day after surgery, and on days 4 and 5 ibuprofen was again significantly superior to dihydrocodeine 60 mg. Roughly half the patients taking dihydrocodeine stopped the study on the day after surgery, because of adverse effects and/or inadequate relief, compared with 6 out of 44 taking ibuprofen. Dihydrocodeine 60 mg produced four times the number of patients affected by adverse effects compared with ibuprofen, and dihydrocodeine 30 mg three times as many. The principal adverse effects were nausea, vomiting and drowsiness. In conclusion, ibuprofen produced better analgesia than dihydrocodeine with significantly fewer adverse effects and is therefore a better choice for pain relief after oral surgery.

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