Comparative Efficacy of Oral Ibuprofen Arginine and Intramuscular Ketorolac in Patients with Postoperative Pain (original) (raw)
Related papers
The Effect of Ibuprofen on Postoperative Opioid Consumption Following Total Hip Replacement Surgery
Turkish Journal of Anesthesia and Reanimation
Objective: Postoperative pain following hip surgery can be severe. Non-steroidal anti-inflammatory drugs are used in the treatment of postoperative pain to reduce opioid consumption. Our aim was to investigate the effect of ibuprofen on postoperative opioid consumption following total hip replacement surgery. Methods: Patients undergoing elective total hip replacement under general anaesthesia were included into this randomised, prospective and double-blind study. Forty patients classified according to the American Society of Anesthesiologists as Class I and II were randomised to receive 800 mg ibuprofen intravenously (IV) every 6 hours, or placebo. At the end of surgery, all patients were also administered tramadol 100 mg IV and paracetamol 1 gm IV. In the postoperative period, all patients were provided with a morphine PCA device. The PCA device was set to deliver 1 mg bolus dose and had 8 minutes of lockout period and 6 mg 1-hour limit. VAS scores were recorded at 1, 6, 12 and 24 h postoperatively. The incidence of nausea and vomiting, total morphine consumption during the 24 h postoperative period was recorded. The Mann-Whitney U and chi-squared tests were used for statistical analysis. Results: The VAS score at postoperative 24 h was lower in the ibuprofen group (p=0.006). Morphine consumption at 24 hours was significantly lower at the ibuprofen group compared to the control group (p=0.026) (the mean doses were 16 mg and 24 mg, respectively). Five patients in the control group and 3 patients in the ibuprofen group reported vomiting. No other side effects or complications were observed. Conclusion: Following total hip replacement surgery, the administration of ibuprofen IV significantly reduced morphine consumption.
Acta Anaesthesiologica Scandinavica, 1995
The postoperahve analgesic effect of ibuprofen was compared with a combinahon of ibuprofen and codeine versus placebo. The study was prospecuve, randomized, double bhnd w t h 123 consecutive hip arth~oplas~y operaaons. All the pahents received oral diazepam as premedicahon and spinal anaesthesia with bupivacaine 5 mg/ml3-4 ml Postoperatively, when the spinal anaesthesia started to wear off, the pahents were randomly assi\gned to one of three groups. the ibuprofen group (n=48) received 800 mg of ibuprofen orally. The ibuprofen/codeine q-oup (IC, n=48) received 800 mg of ibuprofen combined w t h 60 mg of codeine The placebo group (P, n=25), recelved oral placebo medlcation. The patlents were observed for the need of addiuonal opioid (e g. ketobemidone), pain score (verbal and VAS), bleeding and side effects for five hours The paaents in the placebo ,group (p) had significantly higher p a n scores (P<0 05) compared with the two other groups after 2 and 4 hours, wth no significant differences after 1, 3 nnd 5 hours The P group also received 45% more opioids jP<0.001) compared w t h the two other groups dunng the same penod. No significant differences in bleeding or side-effects uere observed between the group? Thew were no significant differences between the ibuprofen qroup and the ibuprofedcodeine L o u p We conclude that a prophylactic dose of 800 mg ibuprofen orally has an opioid spanng effect uith a tendcncy of lrss p a n experience dunng the fiist hours after hip arthroplasty.
Minerva anestesiologica, 2012
We tested the hypothesis that pain relief after total hip replacement (THR) can be obtained with a multimodal approach using oral controlled release (CR) oxycodone plus IV paracetamol. Two hundred and sixty patients undergoing THR were randomized into two groups. A group of 130 patients (EPI) under epidural anesthesia followed by continuous infusion of levobupivacaine 0.125% and sufentanil 0.7 mcg/mL at 7 mL/h was compared with a group (OXY) of 130 patients under spinal anesthesia and oral CR oxycodone 10 mg/q12h plus IV paracetamol 1g/q6h. Pain intensity at rest and dynamic by visual analogue scores (VAS), rescue dose consumption and side effects of three postoperative days (POD) were collected and analyzed with Mann-Withney test (P<0.05 was considered significant). VAS values at rest were similar in both groups at POD#1, significantly lower in the OXY group either at POD#2 (P=0.018) and POD#3 (P=0.001). Dynamic VAS values were significantly lower in the EPI group at POD#1 (P=0....
Frontiers in Surgery
Introduction: Acute postoperative pain following knee arthroscopy is common in orthopedic surgeries. Managing pain postoperatively combines usage of opioids and non-steroidal anti-inflammatory drugs. The aim of this clinical study was to assess the efficacy of two different analgesic treatment regimens: intravenous (IV) ibuprofen and IV ketorolac for the treatment of postoperative pain pertaining to arthroscopic knee surgery. Methods: This was a single center, randomized, double-blind, parallel, active comparator clinical pilot study. Subjects were randomized to receive either IV ibuprofen, administered as two 800 mg doses or IV ketorolac, administered as a single 30 mg dose. Subjects in the ibuprofen group received 800 mg of IV ibuprofen within 2 h prior to surgery and a repeated second dose 4 h after the initial dose if they had not been discharged. Subjects in the ketorolac group received IV ketorolac 30 mg at the end of surgery, as per the manufacturer's recommendations. Pain assessments and opioid consumption data were collected up to 24 h postoperatively. Results: Of 53 randomized subjects, 51 completed the study. There were 20 subjects in the ibuprofen group and 31 subjects in the ketorolac group. The median (IQR) visual analog scale (VAS) pain score at resting upon post-anesthesia care unit (PACU) arrival was 33 (12, 52) vs. 9 (2, 25) (p = 0.0064) for the ketorolac and ibuprofen group, respectively. The median (IQR) visual analog scale (VAS) pain score at movement upon PACU arrival was 38 (20, 61) vs. 15 (6, 31) (p = 0.0018) for the ketorolac and ibuprofen group, respectively. Median VAS pain scores during movement taken at subsequent 30 min intervals in the ibuprofen group were less than half that of those reported in the ketorolac group for up to 90 min after arriving in PACU. The median VAS pain scores at rest and movement in the course of 120 min−24 h after PACU arrival was not statistically significant in both groups. Rescue opioid medication during PACU stay was required in 55.0% (N = 11) and 83.9% (N = 26), with a mean amount of narcotic Conclusion: This pilot study showed that the use of preemptive IV ibuprofen 800 mg could be considered to reduce postoperative pain and opioid consumption. Future prospective clinical trials using similar regimens should be conducted in order to gain a better understanding of how to best provide perioperative analgesic regimens.
Intravenous ibuprofen as an adjunct in acute postoperative pain: A review
Journal of Society of Anesthesiologists of Nepal
Background: Postoperative pain can have a significant effect on patient recovery. Studies suggest that 82% patients experience some pain following surgery, of those 47% complaining of moderate pain, 39% experiencing severe to very severe pain. The failure to adequately treat postoperative pain is due to limitations of monotherapy with opioid analgesics. Intravenous ibuprofen is a nonsteroidal antiinflammatory drug with anti-inflammatory, antipyretic, and analgesic properties that may be related to prostaglandin synthetase inhibition and have been shown to reduce opioid requirements with better postoperative pain management. This paper reviews analgesic outcomes of intravenous ibuprofen as an adjunct to opioid for acute postoperative pain in adults. Methods: Relevant studies were searched using cochrane database of systematic reviews, embase and pubmed databases using key words about intravenous ibuprofen and postoperative pain that were appropriate to each database. Results: Tools to assess pain intensity such as visual analog scale, verbal response scale and self-report of pain scores at rest and with movement have been studied. Multimodal approach with preemptive use of nonsteroidal anti-inflammatory drugs for treatment of postoperative pain is considered. Conclusion: Randomized controlled trials and other studies concluded that postoperative pain control protocols can now consider inclusion of intravenous ibuprofen as an adjunct in multimodal approach to offer patients a significant analgesic benefit while reducing the risks associated with opioid administration.
European Journal of Clinical Pharmacology, 2002
Ibuprofen is a safe and effective analgesic, but some formulations have a slow onset of action. Ibuprofen arginate is a rapidly absorbed salt designed to promote more rapid onset of analgesia. A clinical trial was conducted in 226 patients with postoperative dental pain to assess the analgesic efficacy and speed of onset of the arginine salt of ibuprofen compared with one of the commercially available forms of ibuprofen. Patients were administered a single dose of either ibuprofen arginate (200 mg or 400 mg), ibuprofen (200 mg or 400 mg), or placebo in this double-blind, randomized trial. To determine the onset of action of the study medication patients were required to note time to ''any'' pain relief and then time to ''meaningful'' pain relief, using the two-stopwatch method. Pain intensity and relief were assessed using traditional categorical scales over a 6-h period. Meaningful pain relief was achieved in 42 min and 24 min for ibuprofen arginate 200 mg and 400 mg, respectively, compared with 50 min and 48 min for ibuprofen 200 mg and 400 mg, respectively (P<0.05). The results for the measurements of analgesic effectiveness [sum of pain intensity difference, total pain relief (TOTPAR), peak pain relief and overall evaluation of treatment] all showed that both doses of ibuprofen arginate and both doses of ibuprofen were significantly better than placebo and both 200-mg and 400-mg ibuprofen arginate doses were significantly better than ibuprofen 200 mg for peak pain relief. Mean plasma ibuprofen concentrations at 30 min and 60 min, respectively, were: ibuprofen arginine 200 mg, 13.9 lg/ml and 15.7 lg/ml; ibuprofen arginine 400 mg, 29.5 lg/ml and 29.3 lg/ml; ibuprofen 200 mg 2.5 lg/ml and 5 lg/ ml; ibuprofen 400 mg, 2.3 lg/ml and 7.4 lg/ml. (P<0.05). Adverse event profiles were similar across treatment groups. These results overall suggest that ibuprofen arginate when taken at doses equivalent to commercially available ibuprofen formulations produces analgesia that is faster in onset.
Anesthesiology Research and Practice, 2014
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II–IV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice.