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BJA Advance Access originally published online on April 15, 2005
British Journal of Anaesthesia 2005 94(6):710-714; doi:10.1093/bja/aei144
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org

COMMENTARY

Predicting postoperative analgesia outcomes: NNT league tables or procedure-specific evidence?{dagger}

A. Gray1, H. Kehlet2,*, F. Bonnet3 and N. Rawal4

1 Medical Department, IdeaPharma Ltd, Cranfield, UK. 2 Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen, Denmark. 3 Service Anesthesie Reanimation, Hôpital Tenon, Paris, France. 4 Department of Anaesthesia and Intensive Care, University Hospital, Örebro, Sweden

* Corresponding author: Section for Surgical Pathophysiology, The Juliane Marie Centre 4074, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail: henrik.kehlet{at}rh.dk

Number needed to treat (NNT) values have been recommended and used to assess efficacy of analgesics for acute pain management. However, the data analysed come from a variety of procedures, which may potentially hinder the interpretation of the NNT value for specific procedures. We reanalysed available NNT data with acetaminophen in relation to the magnitude of surgical injury. Acetaminophen was less effective for pain relief after orthopaedic procedures than after dental procedures. The relative risk ratio for more than 50% pain relief, compared with placebo, was only 1.87 compared with 3.77 (P<0.05). Although NNT can give a valuable overview of efficacy, this concept is not necessarily applicable to all types of surgery. We suggest that estimates of NNT should be related to specific surgical procedures.

{dagger} Declaration of interest. The authors are members of the Procedure Specific Postoperative Pain Management (PROSPECT) Group, which conducts procedure-specific systematic reviews of the literature using the Cochrane Protocol, supplements these with evidence from other procedures and from clinical practice, and produces guidelines for the management of postoperative pain. The PROSPECT Group is funded by an unrestricted educational grant from Pfizer Inc., who provided financial support for the writing of this article.


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