OPTIMIZING POSTOPERATIVE ANALGESIA: A RANDOMIZED COMPARISON OF INTRAVENOUS IBUPROFEN AND PARACETAMOL IN ABDOMINAL STOMA CLOSURE
Main Article Content
Keywords
Intravenous ibuprofen, Intravenous paracetamol, abdominal stoma closure surgery, VAS scores.
Abstract
Background: Postoperative pain is a common challenge following abdominal stoma closure surgeries. This study aimed to compare the analgesic efficacy of intravenous (IV) ibuprofen with IV paracetamol in adult patients undergoing these surgeries under subarachnoid block.
Materials and Methods: A total of 132 patients were randomly allocated into two groups: Group I (n=66) received IV ibuprofen (20mg/kg) every 6 hours, and Group P (n=66) received IV paracetamol (15mg/kg) every 6 hours. Data collected included age, gender, anthropometric parameters, duration of surgery, Visual Analog Scale (VAS) scores at rest and during movement at various time intervals (0, 1, 2, 6, 12, 18, 24 hours), and any adverse effects. Rescue analgesia (IV tramadol 1mg/kg) was administered if the VAS score exceeded 40mm.
Results: Postoperative VAS scores at rest showed no statistically significant difference between the two groups throughout the observed intervals. For VAS scores on movement, Group I showed significantly lower scores at 0 hours and 6 hours compared to Group P (p=0.019 and p=0.016, respectively), though this difference was not considered clinically significant. While 21 patients in Group I and 34 patients in Group P required rescue tramadol, indicating a statistically significant difference in the incidence of rescue analgesia (p=0.022), the mean dosage of tramadol consumed was also statistically significantly lower in Group I (24.2 ± 37.2 mg) compared to Group P (39.4 ± 41.4 mg) (p=0.029). Adverse effects were observed in 11 patients (16.7%) in Group I and 4 patients (6%) in Group P, with no statistically significant difference between groups.
Conclusions: The analgesic efficacy of IV ibuprofen was found to be equivalent to IV paracetamol in terms of VAS scores but demonstrated a statistically significant reduction in the incidence and mean dosage of rescue analgesia compared to IV paracetamol in adult patients undergoing abdominal stoma closure surgeries under subarachnoid block. Both agents showed comparable adverse effects. These findings suggest a potential advantage of IV ibuprofen in reducing opioid requirements.
References
2. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. Pain Pract. 2017;17(7):806-815.
3. Sommer M, de Rijke JM, van Kleef M, et al. The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol. 2008;25(4):267-274.
4. Medina-Vera AJ, Novoa LM. Reduced anaesthetic requirements and postoperative analgesics in patients undergoing laparoscopic cholelecystectomy: premedication with intravenous paracetamol versus ketorolac, a double blind and randomised clinical trial. Rev Esp Anestesiol Reanim. 2017;64:64-70.
5. Gousheh SM, Nesioonpour S, Javaher Foroosh F, Akhondzadeh R, Sahafi SA, Alizadeh Z. Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy. Anesth Pain Med. 2013;31:214-8.
6. Bhatia A, Singh S, Kumar S, et al. Anesthesia and postoperative pain control—multimodal anesthesia protocol. J Spine Surg. 2018;4(2):331-338.
7. Tunali Y, Akcil EF, Dilmen OK, Tutuncu AC, Koksal GM, Akbas S, et al. Efficacy of Intravenous Paracetamol and Dexketoprofen on Postoperative Pain and Morphine Consumption after a lumbar disk surgery. J Neurosurg Anesthesiol. 2013;25.
8. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011 Mar- Apr;14(2):145-61.
9. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-157.
10. Martinez GA, Rodriguez BE, Planas RA, Martinez RA. Intravenous Ibuprofen for Treatment of Post-Operative pain: A Multicenter, Double Blinded, Placebo-controlled, Randomized Clinical Trial. PLoS ONE. 2016;11:5-10.
11. Kayhan GE, Sanli M, Ozgul O, Kirteke R, Yologlu S. Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial. J Clin Anesth. 2018;50:5-11.
12. Beck DE, Margolin DA, Babin SF, Russo CT. Benefits of a multimodal regimen for postsurgical pain management in colorectal surgery. Ochsner J. 2015 Winter; 15(4): 408-12.
13. Ekinci M, Ciftci B, Celik EC, Kose EA, Karakaya MA, Ozdenkaya Y. A Randomized, Placebo-Controlled, Double-Blind Study that Evaluates Efficacy of Intravenous Ibuprofen and Acetaminophen for Postoperative Pain Treatment Following Laparoscopic Cholecystectomy Surgery. J Gastrointest Surg. 2020;24:780-85.
14. Ciftci B, Ekinci M, Celik EC, Kaciroglu A, Karakaya MA, Demiraran Y, Ozdenkaya Y. Comparison of Intravenous Ibuprofen and Paracetamol for Postoperative Pain Management after Laparoscopic Sleeve Gastrectomy. A Randomized Controlled Study. Obes Surg. 2019;29:765-70.
15. Uribe AA, Arbona FL, Flangian DC, Kaeding CC, Palettas M. Comparing the efficacy of IV ibuprofen and ketorolac in the management of postoperative pain following arthroscopic knee surgeries: A randomized double blind active comparator pilot study. Front Surg. 2018;5:59.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Bharani kumar B
Senior Resident, Vardhman Mahavir Medical College and Safdarjung hospital, Delhi-110021, India ORCID: 0000-0003-4568-7902
Dr. Rama Wason
Professor Anaesthesia, ESIMCH, NIT 3, Faridabad, Haryana, India Orcid id--0009-0009-1101-2772
Dr. Dishank Rawat
Senior resident, Vardhman Mahavir Medical College and Safdarjung hospital, Delhi-110021, India ORCID: 0000-0002-6357-0938
Dr. Amodini Kukreja
Senior resident , Vardhman Mahavir Medical College and Safdarjung hospital, Delhi-110021, India ORCID: 0000-0002-7294-6597
Dr. Rohan Khandelwal
MBBS MD anaesthesia, Senior resident, Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung hospital, Delhi-110021, India. ORCID- 0009-0004-4212-2687
Dr. Sakshi Khandelwal
MBBS MD anaesthesia, Senior resident, Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung hospital, Delhi-110021, India. ORCID- 0009-0000-3366-5234