Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy

Elif Oral Ahiskalioglu, Ali Ahiskalioglu, Pelin Aydin, Ahmet Murat Yayik, Ayetullah Temiz, Elif Oral Ahiskalioglu, Ali Ahiskalioglu, Pelin Aydin, Ahmet Murat Yayik, Ayetullah Temiz

Abstract

Background: Although studies involving intravenous (IV) ibuprofen are still limited, it has been shown to have a potential role in the treatment of postoperative pain. The primary objective of this study was to investigate the effects of preemptive IV ibuprofen on postoperative 24 hour opioid consumption and postoperative pain in patients undergoing laparoscopic cholecystectomy.

Methods: Following ethical committee approval, 60 patients aged 18 to 65, American Society of Anesthesiology (ASA) I-II, and scheduled for laparoscopic cholecystectomy were included in this prospective, randomized, double-blinded study. Patients were randomly divided into 1 of 2 groups. The control group (n = 30) received 100 mL saline solution 30 minutes before surgery, while the ibuprofen group (n = 30) received 400 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgeon using the same technique. Postoperative analgesia was assessed using a visual analogue pain scale (VAS) with active and passive movements. Twenty-four hour postoperative fentanyl consumption with patient-controlled analgesia and additional analgesia requirements were recorded. Postoperative analgesia was established with 1000 mg paracetamol once every 6 hours and patient-controlled IV fentanyl.

Results: Compared with the control group, VAS scores in the IV ibuprofen group were statistically lower at postoperative 30 minutes and 1, 2, 4, 8, 12, and 24 hours (P < 0.001). Twenty-four hour opioid consumption was statistically significantly higher in the control group compared to the ibuprofen group (553.00 ± 257.04 and 303.33 ± 132.08 μcq, respectively, P < 0.001). Additional analgesia use was statistically significantly higher in the control group than in the ibuprofen group (14/30 vs 5/30, respectively, P < 0.001). The rates of nausea and vomiting were higher in group control than in group ibuprofen (13/30 vs 5/30, respectively, P = 0.024). Other side-effects were similar between the groups.

Conclusion: A preemptive single dose of IV ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption in the 1st 24 hours by 45%. It generated lower pain scores in the postoperative period compared with placebo.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram of study.
Figure 2
Figure 2
Fentanyl consumption of groups at postoperative time points.

References

    1. Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg 1992;127:917–21. discussion 921–913.
    1. Johansson M, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 2005;92:44–9.
    1. Protic M, Veljkovic R, Bilchik AJ, et al. Prospective randomized controlled trial comparing standard analgesia with combined intra-operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy. Surg Endosc 2017;31:704–13.
    1. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Brish J Anaesth 2001;87:62–72.
    1. American Society of Anesthesiologists Task Force on Acute Pain Management Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012;116:248–73.
    1. Woolf CJ. Somatic pain – pathogenesis and prevention. Br J Anaesth 1995;75:169–76.
    1. Woolf CJ, Chong MS. Preemptive analgesia – treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362–79.
    1. Gago Martinez A, Escontrela Rodriguez B, Planas Roca A, et al. Intravenous ibuprofen for treatment of post-operative pain: a multicenter, double blind, placebo-controlled, randomized clinical trial. PLoS One 2016;11:e0154004.
    1. Kroll PB, Meadows L, Rock A, et al. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen (i.v.-ibuprofen) in the management of postoperative pain following abdominal hysterectomy. Pain Pract 2011;11:23–32.
    1. Moss JR, Watcha MF, Bendel LP, et al. A multicenter, randomized, double-blind placebo-controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy. Paediatr Anaesth 2014;24:483–9.
    1. Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth 2001;48:1000–10.
    1. Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002;96:725–41.
    1. Mixter CG, 3rd, Meeker LD, Gavin TJ. Preemptive pain control in patients having laparoscopic hernia repair: a comparison of ketorolac and ibuprofen. Arch Surg 1998;133:432–7.
    1. Fassoulaki A, Patris K, Sarantopoulos C, et al. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002;95:985–91. table of contents.
    1. Ahiskalioglu EO, Ahiskalioglu A, Aydin P, et al. Effects of a single-dose preemptive pregabalin on acute and chronic pain after inguinal hernia repair with mesh under spinal anaesthesia: a randomised controlled trial. Eur J Anaesthesiol 2016;33:605–7.
    1. Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A 2010;20:677–82.
    1. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997;72:95–7.
    1. Saadati K, Razavi MR, Nazemi Salman D, et al. Postoperative pain relief after laparoscopic cholecystectomy: intraperitoneal sodium bicarbonate versus normal saline. Gastroenterol Hepatol Bed Bench 2016;9:189–96.
    1. Blichfeldt-Eckhardt MR, Ording H, Andersen C, et al. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain 2014;155:2400–7.
    1. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet (London, England) 2006;367:1618–25.
    1. Southworth SR, Woodward EJ, Peng A, et al. An integrated safety analysis of intravenous ibuprofen (Caldolor®) in adults. J Pain Res 2015;8:753–65.
    1. Scott LJ. Intravenous ibuprofen: in adults for pain and fever. Drugs 2012;72:1099–109.
    1. Smith HS, Voss B. Pharmacokinetics of intravenous ibuprofen: implications of time of infusion in the treatment of pain and fever. Drugs 2012;72:327–37.
    1. Singla N, Rock A, Pavliv L. A multi-center, randomized, double-blind placebo-controlled trial of intravenous-ibuprofen (IV-ibuprofen) for treatment of pain in post-operative orthopedic adult patients. Pain Med 2010;11:1284–93.
    1. Southworth S, Peters J, Rock A, et al. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen 400 and 800 mg every 6 hours in the management of postoperative pain. Clin Ther 2009;31:1922–35.
    1. Gupta A, Abubaker H, Demas E, et al. A randomized trial comparing the safety and efficacy of intravenous ibuprofen versus ibuprofen and acetaminophen in knee or hip arthroplasty. Pain Physician 2016;19:349–56.
    1. Le V, Kurnutala L, SchianodiCola J, et al. Premedication with intravenous ibuprofen improves recovery characteristics and stress response in adults undergoing laparoscopic cholecystectomy: a randomized controlled trial. Pain Med 2016;17:1163–73.

Source: PubMed

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