Introduction

Management of postoperative pain plays a very important role in achieving clinical outcomes and patient satisfaction. Although opioids are effective in relieving postoperative pain, their use has been associated with adverse effects. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) have been used widely as adjunctive analgesics postoperatively. Ibuprofen, among the other NSAIDs, has been a good option since it is associated with low rate of adverse effects. Both intravenous (IV) acetaminophen and ibuprofen are effective in postoperative analgesia. However, which drug is superior to the other has not been determined.

Aim

To compare the effects of IV ibuprofen and acetaminophen on postoperative opioid consumption and pain intensity after general anesthesia.

Method

Study Design

Study Selection Criteria

• Relevant studies were selected using PubMed/MEDLINE, EMBASE, and Cochrane Library databases up to May 2023. 
• The meta-analysis and TSA included RCTs conducted on adults which compared the effects of perioperative IV ibuprofen and acetaminophen on postoperative opioid consumption and pain after general anesthesia
• Opioids were administered postoperatively via patient-controlled analgesia (PCA) and included morphine, tramadol and fentanyl
• Rescue analgesics were given in case the pain was not adequately controlled
• The postoperative outcomes at 24 hours were assessed

Endpoints

• Postoperative opioid consumption at 4-6 h, 12 h and 24 h
• Pain scores at 4-6 h, 12 h and 24 h postoperatively using VAS scores
• Side effects
• Use of rescue analgesics

Results

• Meta-analysis included eight studies with 494 participants
• IV acetaminophen was administered at a dose of 1000 mg and IV ibuprofen at a dose of 800 mg per administration
• The 24 hr opioid consumption was significantly lower in the ibuprofen group, presented as morphine equivalents (mean difference [MD]: -6.01 mg; p < 0.00001)
• Ibuprofen resulted in lower pain scores at recovery; MD -1.42, p=0.0003
• The Ibuprofen group had lower pain intensity at 4-6 h (MD: -0.83, p = 0.0004) and 12 h (MD: -0.38, p = 0.01) postoperatively
• There were no notable differences in VAS scores at 24 h postoperatively; MD -0.26, p=0.16
• The need for rescue analgesics was lower in the ibuprofen group; RR 0.40, p-0.004
• Nausea and vomiting were less with ibuprofen, (RR 0.49 for both) however, there were no significant differences in the rate of other side effects like pruritis, dyspepsia etc.
• Limitation of this meta-analysis is that the sample size was insufficient to evaluate the effects, suggesting more studies for conclusive results

Conclusion

Korean J Anesthesiol. 2024 Aug;77(4):455-467. Doi: 10.4097/kja.24089.