Intravenous Ibuprofen Versus Ketorolac for Perioperative Pain Control in Patients with Morbid Obesity Undergoing Bariatric Surgery: A Randomized Controlled Trial

Abstract

Background: We aimed to compare the perioperative analgesic efficacy of intravenous ibuprofen versus ketorolac in patients with obesity undergoing bariatric surgery. Methods: This randomized controlled trial included adult patients with obesity undergoing bariatric surgery. Participants were randomized to receive either ibuprofen or ketorolac intravenously every 8 h. All patients received paracetamol intravenously 1 gm/6 h. Inadequate intraoperative analgesia was managed by fentanyl boluses, while inadequate postoperative analgesia was managed by nalbuphine boluses. The primary outcome was static visual analogue scale (VAS) 0.5 h postoperatively. Secondary outcomes were postoperative static and dynamic VAS, intra- and postoperative opioids consumption, postoperative nausea and vomiting, and patients’ satisfaction. Results: Fifty-three patients were analyzed in each group. The median VAS (quartiles) at 0.5 h postoperatively was lower in the ketorolac group (3 [3, 6]) than in the ibuprofen group (7 [4, 8]), P-value < 0.001. The static and dynamic VAS were lower in the ketorolac group than in the ibuprofen group up to 6 h postoperatively. The intra- and postoperative opioid consumption was lower in the ketorolac group than in the ibuprofen group. The incidence of postoperative nausea and vomiting was also lower in the ketorolac group than in the ibuprofen group. Patients in the ketorolac group had higher level of satisfaction than patients in the ibuprofen group. Conclusion: In patients with obesity undergoing bariatric surgery, perioperative administration of ketorolac provided improved pain control, reduced opioid consumption, and lowered the risk of postoperative nausea and vomiting, compared to ibuprofen. Additionally, patients reported higher satisfaction with ketorolac.