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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Comparison of intravenous ibuprofen versus ketorolac for postoperative analgesia...
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Vol. 69. Issue 8.
Pages 463-471 (October 2022)
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Vol. 69. Issue 8.
Pages 463-471 (October 2022)
Original article
Comparison of intravenous ibuprofen versus ketorolac for postoperative analgesia in children undergoing lower abdominal surgery: A randomized, controlled, non-inferiority study
Comparación de ibuprofeno y ketorolaco intravenosos para analgesia postoperatoria en niños tratados mediante cirugía de la zona inferior del abdomen: estudio aleatorio, controlado y de no inferioridad
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I. Abdelbaser
Corresponding author
ibraheem2005@mans.edu.eg

Corresponding author.
, N.A. Mageed, E.-S.M. El-Emam, M.M ALseoudy
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Highlights

  • NSAIDs are used as primary analgesics or as part of multimodal analgesia to control postoperative pain.

  • Intravenous ibuprofen was approved only in 2009 to control fever and pain.

  • In adults, the use of intravenous ibuprofen for postoperative analgesia is safe and effective.

  • Intravenous ibuprofen can be used as an alternative to ketorolac for postoperative analgesia in children.

  • Intravenous ibuprofen and ketorolac provide safe and effective analgesia after pediatric lower abdominal surgery.

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Abstract
Background

Non-steroidal anti-inflammatory drugs are often used as part of multimodal analgesia to control postoperative pain. This randomized, controlled, double-blinded, non-inferiority study aimed to compare the postoperative analgesic effects of intravenous ibuprofen versus ketorolac in children undergoing open unilateral lower abdominal surgery. The authors hypothesized that postoperative analgesia produced by intravenous ibuprofen would be non-inferior to that of intravenous ketorolac.

Methods

Sixty-six children aged 2 to 8 years who were scheduled to undergo unilateral lower abdominal surgery, were recruited. Patients in the ibuprofen group received 10mg/kg/6h intravenous ibuprofen. Patients in the ketorolac group were given 0.5mg/kg/6h intravenous ketorolac. The primary outcome measure was 24-h postoperative morphine consumption. The secondary outcome measures were postoperative pain score, the incidence of early postoperative fever and the incidence of ibuprofen and ketorolac adverse effects including pain during drug infusion, vomiting, epigastric pain and allergic reaction.

Results

Fifty-nine patients completed the study (30 ibuprofen, 29 ketorolac). There was no significant difference (P=0.305) in the mean (SD) 24-h postoperative morphine consumption (μ/kg) between intravenous ibuprofen, 16.00 (5.31), and ketorolac, 14.65 (4.61). The reported pain scores were similar in both groups. The incidence of postoperative fever was significantly lower (p=0.039) in the ibuprofen group (3%) than the ketorolac group (20%). The incidence of adverse effects was similar in both ibuprofen and ketorolac groups.

Conclusions

Intravenous ibuprofen can be used as an alternative to ketorolac for postoperative analgesia in children undergoing unilateral lower abdominal surgery because both drugs similarly provide safe and effective postoperative analgesia.

Keywords:
Intravenous ibuprofen
Children
Ketorolac
Abdominal surgery
Postoperative analgesia
Resumen
Antecedentes

A menudo se utilizan antiinflamatorios no esteroideos para analgesia multimodal, para controlar el dolor postoperatorio. El objetivo de este estudio aleatorio, controlado, doble ciego y de no inferioridad fue comparar los efectos analgésicos postoperatorios de ibuprofeno y ketorolaco intravenosos en niños sometidos a cirugía unilateral abierta de la zona inferior del abdomen. Los autores supusieron que la analgesia postoperatoria producida por ibuprofeno intravenoso no sería inferior a la de ketorolaco intravenoso.

Métodos

Sesenta y seis niños de 2 a 8 años de edad fueron programados para cirugía unilateral de la zona inferior del abdomen. Los pacientes del grupo ibuprofeno recibieron 10mg/kg/6h de ibuprofeno intravenoso, y los pacientes del grupo ketorolaco recibieron 0,5mg/kg/6h de ketorolaco por vía intravenosa. La medida del objetivo primario fue el consumo morfina postoperatoria durante 24h de. Las medidas del resultado secundario fueron la puntuación del dolor postoperatorio, la incidencia de fiebre postoperatoria temprana y la incidencia de efectos adversos relativos a ibuprofeno y ketorolaco incluyendo dolor durante la infusión del fármaco, vómitos, dolor epigástrico y reacción alérgica.

Resultados

Cincuenta y nueve pacientes completaron el estudio (30 de ibuprofeno y 29 de ketorolaco). No se produjo diferencia significativa (P=0,305) en cuanto a consumo medio (DE) de morfina postoperatoria durante 24h (μ/kg) entre el grupo ibuprofeno, 160 (5,31),y el grupo ketorolaco, 14,65 (4,61). Las puntuaciones de dolor reportadas fueron similares en ambos grupos. La incidencia de fiebre postoperatoria fue significativamente menor (p=0,039) en el grupo ibuprofeno (3%) que en el grupo ketorolaco (20%). La incidencia de efectos adversos fue similar en ambos grupos.

Conclusiones

Ibuprofeno intravenoso puede utilizarse como alternativa a ketorolaco para analgesia postoperatoria en niños sometidos a cirugía unilateral de la zona inferior del abdomen, ya que ambos fármacos aportan analgesia postoperatoria segura, efectiva y similar.

Palabras clave:
Ibuprofeno intravenoso
Niños
Ketorolaco
Cirugía abdominal
Analgesia postoperatoria

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