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BRIEF REPORT
Year : 1988  |  Volume : 36  |  Issue : 1  |  Page : 37-40

A comparative study of ibuprofen with paracetamol versus oxyphenbutazone with analgin combination in ophthalmic practice


Professor and Director; Regional Institute of Ophthalmology, Calcutta-700 073, India

Correspondence Address:
I S Roy
Professor and Director; Regional Institute of Ophthalmology, Calcutta-700 073
India
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Source of Support: None, Conflict of Interest: None


PMID: 3253200

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  Abstract 

A total of 200 patients of either sex with various ophthalmic inflammatory disorders of surgical and non-surgical types were treated with ibuprofen with paracetamol 1 tablet tid. or a combination of oxyphenbutazone and analgin-1 tablet t. i. d. for 7 days/ Patients in the ibuprofen with Paracetamol group recorded a signifi­cantly greater reduction in pain scores; on day 1 and 2 and in swelling scores on day 2, 5 and 7 as compared to patients receiving the combination of ox yphenbutazone and analgin. A significantly lesserr number of patients in the ibuprofen with paraeetamol group required escape analgesics. Seventy six per cent of patients in the Ibuprofen with paracetamol group were judged as showing a Very good - Good, response to treatment as against 55 per cent in the oxvphenbutazone­analgin group. It is concluded that ibuprofen with Paracetamol is superior in efficacy and a safer alternative to a combination of oxyphenbutazone and analgin.

Keywords: Ophthalmic inflammatory disorders, NSAIDs, analge-sies, ibuprofen with Paracetamol, oxyphenbutazone, analgin.


How to cite this article:
Roy I S, Das A, Roy M. A comparative study of ibuprofen with paracetamol versus oxyphenbutazone with analgin combination in ophthalmic practice. Indian J Ophthalmol 1988;36:37-40

How to cite this URL:
Roy I S, Das A, Roy M. A comparative study of ibuprofen with paracetamol versus oxyphenbutazone with analgin combination in ophthalmic practice. Indian J Ophthalmol [serial online] 1988 [cited 2020 Aug 8];36:37-40. Available from: http://www.ijo.in/text.asp?1988/36/1/37/26164



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  Introduction Top


Ocular inflammation is not uncommon after ocular surgery, trauma or due to systemic or local causes. Though topical or systemic steroids are important anti­-inflammatory agents by virtue of their potency, non­steroidal anti- inflammatory drugs (NSAIDs) are also widely used for the symptomatic relief of ophthalmic inflammatory disorders The analgesic action of NSAIDs however, is indirect arising out of their anti-inflamma­tory action [1], and it may take a few days to weeks for them to exert their full therapeutic effcetz. The need to combine simple analgesics along with NSAIDs for the relief of acute pain is, therefore, frequently felt by the physician.

The aim of the present study was to compare the efficacy and safety of two NSAID analgesic combinations one a combination of ibuprofen and paracetamol and the other a combination of oxyphenbutazone and analgin, in the management of inflammatory disorders in ophthalmic practice.


  Materials and Methods Top


A randomised comparative study of two parallel groups of patients, one receiving Ibuprofen with Paracetamol and the other a comination of oxyphenbutazone and analgin was undertaken at the Regional Institute of Ophthalmology, Calcutta from I st August 1986 to 31 st December 1986. A total of200 adult patients of either sex suffering from various painful inflammatory ophthal­mic disorders of surgical or non- surgical types requiring therapy with an anti- inflammatory agent qualified for inclusion in the study. Patients already receiving systemic corticosteroids or anti-inflammatory or anal­gesic drugs and also those suffering from peptic dis­orders were excluded from the study. A complete case history was obtained from every patient and a thorough physical examination performed, both systemic and local. The clinical diagnosis was noted, and the present­ing signs and symptoms such as pain, swelling and congestion were graded on a scale of 0-3 as follows : 0= absent 1 = mild; 2 = moderate and 3 = severe.

Appropriate investigations (eg. biochemistry, bacterio­logy, etc) were carried out as necessary. Patients were randomly assigned to either of the two treatment groups of 100, each one (Gr. A) receiving Ibuprofen with Paracetamol l tablet t i d and the other (Gr. B) 1 tablet of a combination of oxyphenbutazone and analgin t i d for 7 days. Other appropriate treatment such as antibiotics administered to the patient was recorded Topical steroids were administered in appropriate cases; If pain control was inadequate, escape analgesics (ie. paraceta­mol tablets) were administered but were recorded as a negative indication of analgesic activity. The local signs a week as mentioned above and subsequently after two weeks. The occurrence of side effects, if any, was noted and an overall assessment of therapy on a scale of Very good- Poor was made at the end of the treatment period.

Results

[Table - 1] gives the non-surgical and surgical cases of ophthalmic inflammatory disorders included in the study. The distribution of cases in the two treatment groups was comparable.

[Table - 2] gives the- improvement in the various sign/symptom scores in the two treatment groups. Both treatment modes resulted in a significant reduction in the sign/symptom scores by day 1. Patients in the Ibuprofen with Paracetamol group recorded a significantly greater reduction in pain scores on day 1 and 2 [Table - 2] and in swelling scores on day 2, 5 and 7 as compared to patients receiving the combination of oxyphenbutazone and analgin. The reduction in the congestion in the two treatment groups was comparable though patients in the Ibuprofen with Paracetamol group recorded a slightly higher mean reduction.

[Table - 3] gives the number of patients requiring escape analgesics in the two treatment groups and the overall response to treatment Only 3 patients in the Ibuprofen with Paracetamol group as against 14 in the oxyphen­butazone-analgin group required escape analgesics denoting poor pain control. This difference was highly significant A total of 18 patients in the Ibuprofen with Paracetamol group and 46 patients in the oxyphenbuta­zone-analgin group complained of gastric irritation with treatment This difference was also highly signi­ficant (P < 0.1 from X 2 test).

Seventy six patients in the Ibuprofen with Paracetanol group showed very good to good response to treatment as against 55 in the Oxyphenbutazone-analgin group. Only 9 patients in the Ibuprofen with Paracetamol group as against 17 in the Oxyphenbutazone-analgin group showed a poor response. All differences between groups were highly significant at P < 0.01 (Mann­Whitney test).


  Discussion Top


Several disorders in ophthalmic practice present with symptoms of acute inflammation requiring prompt relief Surgical operations of the eye also constitute a source of damage to the issue resulting in an inflamm­atory reaction during the post-operative period Control of inflammation is particularly important in an organ composed of tissues as delicate as the eye, as damage of a degree which may be tolerated by other tissues may well result in permanent damage and scarring with a disas­trous effect of vision[3],[4]. Though corticosteroids constitute a very important group of agents for controlling ocular inflammation, the risk of adverse effects dictates that therapy with these agents should be initiated cautiously. Further, several clinical situations in ophthalmic practice are characterised by ocular inflammation of mild to moderate severity amenable to treatment with non­steroidal anti-inflammatory drugs and analgesics. The use of MAIDS and analgesics with or without corticos­teroids, therefore, constitutes an important part in the management of ophthalmic inflammatory disorders.

Amongst the NSAIDs, the phenylbutazone group of drugs and their combinations were widely used in the past Their potential to cause fatal complications due to blood dyscrasias even with short term use, however, has made then unsuitable for routine use in clinical practice [2],[5],[6],[7]. Propionic acid derivatives, on the other hand, have a low incidence of adverse effects and ibuprofen in particular is better tolerated than aspirin, indomethacin or phenylbutazone [8].

Regarding the choice of a simple analgesic to be com­bined with ibuprofen, the well established safety of paracetamoll [2,9] and its pharmacokinetic compatibility with ibuprofen makes it eminently suited for this purpose. Such a combination of ibuprofen with parace­tamol/has been shown to be superior in efficacy to ibuprofen in acute painful inflammatory disorders in rheumatology and dentistry [10],[11],[12]. A similar superior effi­cacy and tolerance of Ibuprofen with Paracetamol over a combination of oxyphenbutazone and analgin was demonstrated in our present study.

It is concluded that Ibuprofen with Paracetamol is superior in efficacy and a safer alternative to a combina­tion of Oxyphenbutazone and analgin in the manage­ment of inflammatory ophthalmic disorders of surgical and non-surgical types.

 
  References Top

1.
Golding D. N., Basic Management of Arthritis and rheumatism In Problems in Arithritis and Rheumatics, M.T. P. Press Ltd., pp. 51-74, 1981.  Back to cited text no. 1
    
2.
Huskisson E.G, Practical Aspects in selecting and prescribing antirheumatics drugs, In: Handbook of Drug Therapy In Rheumaatology, Roth S. H. (ed), PSG Publishing Co., 79-113, 1985.  Back to cited text no. 2
    
3.
Miller S.J.H., General Therapeutics In: Parsons Diseases of the Eye, E LBS and Churchill Livingstone: Sixteenth ed.; pp. 141-150, 1984.  Back to cited text no. 3
    
4.
Havener W.H., Corticosteroid Therapy In: Ocular Pharmacology, The CV. Mosby Co, Fifth Edition: 433-500, 1978.  Back to cited text no. 4
    
5.
The International Agranulocytosis and Aplastic anaemia study. Risks of agranulocytosis and aplastic anaemia JAMA, 256, 1749­1757,1986.  Back to cited text no. 5
    
6.
Flower RJ., Moncala S., Vanu J. R, Analgesics, Antipyretics and Anti-inflammatory agents : Drugs employed in the treatment of gout in: Goodman & Gillmans. The Pharmacological Basis of Therapeutics, Gilman AG., Goodman LS., Rall T.W. et al. (eds) MacMillan Publishing Co.; Seventh edition : pp. 674-71 . 5, 1980.  Back to cited text no. 6
    
7.
Kean W. F. and Buchanan W. W., Rheumatoid Arthritis : Some personal considerations on treatment Br. J. Clin. Pract, 37 : 45-52, 1983.  Back to cited text no. 7
    
8.
Anti-arthritic Drugs IN: AMA Drug Evaluations, W.B. Saunders Ca; Fifth edition : pp. 107-38, 1985.  Back to cited text no. 8
    
9.
Anti-pyretic Analgesics IN: Drug Facts and Comparisons, Boyd JR. (ed), J.B. Lippincolt Co.; pp. 787-790, 1982.  Back to cited text no. 9
    
10.
Patel B, A Comparative clinical trial of Combiflam versus ibuprofen in Rheumatic Disorders, The Med & Surg Vol. XXV, No. 7, pp. 7-10, 1985.  Back to cited text no. 10
    
11.
Parulkar B. P., A comparative study of Combiflam versus ibuprofen in the management of painful inflammatory disorders in dental practice, Curr. Med Pract 29 :211-217. practice, Curr. Med Pract 29: 211-217, 1985.  Back to cited text no. 11
    
12.
Kakkar J.N., A comparative clinical study of Combiflam versus ibuprofen in rheumatic disorders, The Antiseptic 83 : 625-633, 1986.  Back to cited text no. 12
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

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