Introduction
Opioids are standard for severe post-operative pain, but multimodal pain management can reduce opioid use. Previous trials show IV ibuprofen reduces pain and morphine consumption.
Aim
To determine if pre- and post-operative IV ibuprofen reduced pain and morphine use in orthopedic surgery patients compared to placebo.
Patient Profile
- N=185 adult patients (18-80 years) undergoing elective hip or knee surgery
- Need for post-op I.V. morphine analgesia with anticipated use of >28 hours
- Excluded: patients with opioid dependence, significant bleeding disorders, or severe organ dysfunction
Methods
- Multi-center, randomized, double-blind, placebo-controlled trial
- Study Groups: Starting pre-operatively, patients randomized to receive
- 800 mg IV ibuprofen every 6 hours (n=99)
OR
- Placebo every 6 hours (n=86)
- 800 mg IV ibuprofen every 6 hours (n=99)
- All had access to patient-controlled analgesia (PCA) morphine for rescue
Study endpoints
Primary:
- Self-assessment of surgical pain with movement (VASM), using a visual analog scale (VAS) during 6-28 hours post-op
Secondary:
- Pain at rest measured by VAS assessed at rest (VASR) and verbal response scale (VRS) during 6-28 hours post-op
- Post-operative morphine consumption
- Treatment failure, time to resume activities, opioid side effects, and hospital stay
Results
Efficacy
Table 1: Summary of Study Results
|
Measure |
Placebo (n=86) |
IV-Ibuprofen (n=99) |
Difference |
Reduction |
Percentage Reduction |
P-value |
|
VAS with Movement (AUC 6-28 hours) |
1,307.8 (388.7) |
970.1 (422.2) |
-321.1 |
337.7 |
25.8% |
<0.001 |
|
VAS at Rest (AUC 6-28 hours) |
910.9 (424.3) |
620.8 (401.0) |
-269.0 |
290.1 |
31.8% |
<0.001 |
|
Verbal Response Scale (AUC 6-28 hours) |
49.5 (18.2) |
39.5 (17.1) |
-8.6 |
10.0 |
20.2% |
<0.001 |
|
Morphine Consumption (mg, 6-28 hours) |
59.5 (29.9) |
41.1 (27.3) |
-16.6 |
18.4 |
30.9% |
<0.001 |
|
Early Post-Op VAS with Movement |
80.4 (22.4) |
69.2 (29.3) |
-11.0 |
11.2 |
13.9% |
0.003 |
|
Early Post-Op VAS at Rest |
69.8 (29.0) |
58.8 (31.5) |
-10.7 |
11.0 |
15.8% |
0.012 |
- Pain Reduction: IV ibuprofen reduced mean AUC-VASM by 25.8% (P<0.001) and AUC-VASR by 31.8% (P<0.001)
- Morphine Use: 30.9% less morphine used in IV ibuprofen group (P<0.001)
Safety
Similar adverse events in both groups; no significant differences in serious adverse events
Conclusion
- Pre- and post-op IV ibuprofen effectively reduced pain and morphine use in orthopedic surgery patients
- 800 mg dose provided analgesic benefit and narcotic reduction, offering a safe multimodal pain management option
Reference
Pain Medicine 2010; 11: 1284–1293
