A Systematic Review and Meta-analysis of Randomised Controlled Trials Comparing the Post-operative Efficacy of Ibuprofen and Acetaminophen with Codeine in Paediatric Patients

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Abstract Background: To evaluate and compare the efficacy of ibuprofen and acetaminophen with codeine in managing post-operative pain in paediatric patients. The review seeks to determine which analgesic is more effective in reducing pain intensity, minimising post-operative agitation and reducing the need for additional analgesics. Material and Methods: We conducted a comprehensive search across electronic databases, including PubMed, Scopus, Web of Science and Cochrane Library. Statistical analyses were performed using R software 4.2.2. Effect sizes (Cohen’s d) and variances were calculated by first converting P values into Z-scores using Z = qnorm (1 − P/2) for two-tailed tests. Cohen’s d was then approximated as d = Z/√(n1 + n2)/2, where n1 and n2 are the sample sizes. Variance was calculated as 1/(n1 + n2). Heterogeneity was assessed with the Cochrane Q P value and I² statistic, using both random effects and common effect models. Publication bias was evaluated with funnel plots and Egger’s regression test. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: The meta-analysis comparing ibuprofen to acetaminophen with codeine across five studies demonstrates a very small overall effect size favouring ibuprofen, with a standardised mean difference of 0.0701 (95% confidence interval: −0.0143–0.1545) in the random effects model. This effect is not statistically significant (P = 0.1034), and the confidence interval includes zero, suggesting that the observed difference may be attributable to chance. The heterogeneity assessment indicates no significant variation among studies (I² =0.0%, P = 0.4834), reflecting consistency in the results. Therefore, the analysis does not provide strong evidence for the superiority of ibuprofen over acetaminophen with codeine, as both treatments appear to offer similar efficacy. Conclusion: The meta-analysis indicates a minimal, statistically non-significant advantage for ibuprofen compared to acetaminophen with codeine. The results show no substantial difference between the two treatments, suggesting that both are similarly effective for pain management.