Comparison of ibuprofen and acetaminophen with codeine following cosmetic facial surgery

J Otolaryngol Head Neck Surg. 2009 Oct;38(5):580-6.


Objectives: To compare the efficacy and side effects of ibuprofen and acetaminophen with codeine when given postoperatively following cosmetic facial surgery and to assess whether bruising is worse or the incidence of hematoma is greater when ibuprofen is taken postoperatively.

Design: Prospective, double-blind, randomized trial.

Setting: Accredited outpatient surgery centre.

Methods: Study subjects received scheduled doses of either oral ibuprofen 400 mg or acetaminophen/codeine 600/60 mg four times a day through postoperative day 3. They recorded their pain level on a 10 cm visual analogue scale, as well as any untoward side effects, at scheduled times throughout the first 3 postoperative days. Severity of bruising was assessed on postoperative day 4. Any postoperative hematomas were managed and recorded.

Results: There was no significant difference in pain relief or average bruising scores between the two groups. Subjects receiving ibuprofen had significantly fewer adverse side effects and were less likely to change medications than those receiving acetaminophen with codeine. None of the patients in either group developed a postoperative hematoma.

Conclusions: Ibuprofen 400 mg is as effective as acetaminophen/codeine 600/60 mg for pain relief following cosmetic facial surgery. Ibuprofen is better tolerated, with fewer side effects, than acetaminophen with codeine. Ibuprofen given postoperatively does not result in increased bruising or increased incidence of hematoma.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / adverse effects
  • Acetaminophen / therapeutic use*
  • Analgesics / adverse effects
  • Analgesics / therapeutic use*
  • Codeine / adverse effects
  • Codeine / therapeutic use*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Face / surgery
  • Humans
  • Ibuprofen / adverse effects
  • Ibuprofen / therapeutic use*
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Prospective Studies
  • Surgery, Plastic*
  • Treatment Outcome


  • Analgesics
  • Acetaminophen
  • Codeine
  • Ibuprofen