A Randomized Controlled Trial Comparing Acetaminophen, Acetaminophen and Ibuprofen, and Acetaminophen and Codeine for Postoperative Pain Relief After Mohs Surgery and Cutaneous Reconstruction

BACKGROUND There are no population-based data comparing analgesics after Mohs micrographic surgery (MMS) and reconstruction. OBJECTIVE To compare the efficacy in pain management of three analgesic combinations. METHODS In a randomized, double-blind, controlled study, patients undergoing MMS and reconstruction for head and neck skin cancers received 1,000mg of acetaminophen (Ac), 1,000mg Ac plus 400mg ibuprofen (Ib), or 325mg Ac plus 30mg codeine (Co) immediately after surgery and every 4 hours for up to four doses. Patients rated their pain on a visual analog scale (VAS) 0, 2, 4, 8, and 12 hours after surgery and recorded medication-related side effects. RESULTS The Ac+Ib group had the lowest pain scores (mean change from baseline/immeditely prior to surgery) at each postoperative recorded time interval and a significantly smaller change from baseline pain scores than the Ac+Co group at 4 hours (p = .005) and the Ac group at 8 hours (p = .02). Ac+Ib was also superior in pain control for patients with surgical areas smaller than 10 cm(2). Complications in the Ib+Ac group were significantly lower than in the Ac+Co group but not the Ac group. CONCLUSIONS The combination of Ac+Ib is superior to Ac alone or Ac+Co in controlling postoperative pain after MMS and cutaneous reconstruction.