Comparison of analgesic effects of paracetamol and ibuprofen after laparoscopic cholecystectomy

Abstract

Objective: Non-steroid anti-inflammatory drugs (NSAIDs) and paracetamol (P) are frequent constituents of multimodal postoperative analgesia. The aim of this study was to compare analgesic effects of intravenous (IV) paracetamol and ibuprofen (IB) administered intraoperatively and in repeated doses postoperatively to the patients who underwent laparoscopic cholecystectomy. Material and Methods: A total of 40 patients with class of American Society of Anesthesiologists (ASA) I-III who underwent laparoscopic cholecystectomy were randomized into Groups-P and IB in this randomized, prospective and double-blind study. After anesthesia induction and initiation of the surgery, Group-P patients received 1 g IV paracetamol and Group-IB patients received 800 mg IV ibuprofen. At skin closure, 1.5 mg/kg of IV tramadol was administered. For postoperative analgesia, a patient-controlled analgesia (PCA) pump with tramadol was used. During the first 24h postoperatively, Group-P patients received 1 g of IV paracetamol and Group-IB patients received 400 mg of IV ibuprofen at every 6h. Patients with visual analog pain scale (VAS) scores = 4 received rescue analgesia. The groups were compared for postoperative first 24h VAS scores, PCA demand, total tramadol dose, and rescue analgesic requirement. Results: Compared with Group-P, Group-IB had significantly lower VAS-awakening, VAS-post-anesthesia care unit (PACU) and VAS- 6th h scores. Postoperative rescue analgesic requirement was lower in Group-IB than in Group-P at all timepoints, most notably in the PACU. Conclusion: Compared with paracetamol, intraoperative and repeated postoperative doses of ibuprofen substantially decreased the pain scores and rescue analgesic requirement. As a component of multimodal analgesia, IV ibuprofen is an effective option for postoperative pain management.