Background: Effective pain management is essential for patient recovery and quality of life. Paracetamol (Acetaminophen) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used analgesics, but their comparative efficacy remains debated. Objective: To systematically review and compare the efficacy of paracetamol and NSAIDs in various pain scenarios. Methods: A comprehensive search was conducted across major databases, primarily using PubMed. The search yielded studies that compared paracetamol to any NSAID in human trials. Following strict inclusion and exclusion criteria, 11 studies with 3,038 participants were finally included in the review. Results:
Paracetamol demonstrated comparable efficacy to NSAIDs in multiple scenarios such as post-trauma, post-partial Mastectomy Pain, and migraine in children. While, in certain situations like postoperative pain after Day-Case Operative Hysteroscopy, Pain Post-Total Hip Arthroplasty, and Pain during Rapid Maxillary Expansion, NSAIDs showcased superior efficacy. In some cases, however, such as renal colic, conflicting study evidence was presented. Moreover, in acute settings when administered I.V., paracetamol was slightly more effective. Finally, the combination of NSAIDs with paracetamol did not always offer enhanced analgesic effects. Conclusion: The choice between paracetamol and NSAIDs should be based on the specific clinical scenario and patient needs. While paracetamol is often seen as a safer option, NSAIDs play a vital role in pain management in certain conditions. Generally, due to its safety profile and less GIT and CVS complications, paracetamol should be preferred in pain management as first-line agent, especially in mild cases before moving to NSAIDS in more moderate to severe cases. The route of administration can also affect the analgesic's efficacy with the IV route showing higher efficacy. The findings highlight the potential for reducing opioid use by optimizing the use of non-opioids.
Key words: Paracetamol, NSAIDS, Acetaminophen, Pain Management
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