Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

Comparison of the prophylactic effect of ibuprofen and intravenous ketorolac in pain control after upper extremity surgery: A Double-Blind Randomized Clinical Trial Study

Document Type : Research Paper

Authors
Majid Vatankhah 1
Mehrdad Melekshoar 2
1 Assistant Professor of Anesthesiology, Intensive Care fellowship, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2 Associated Professor of Anesthesiology, Cardiothoracic anesthesia fellowship, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
10.22038/mjms.2021.18501
Abstract
Introduction: Pain after surgery is an unpleasant experience. This process causes physiological disorders in all systems of the body. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs to control postoperative pain. Therefore, this study was performed to compare the prophylactic effect of intravenous ibuprofen and intravenous ketorolac in pain control after upper extremity surgery. Methods: In this randomized double-blind clinical trial study, 60 patients with anesthesia class I and II underwent upper limb orthopedic surgery. Patients were randomly divided into intravenous ibuprofen and ketorolac. Systolic and diastolic blood pressure, mean arterial pressure and heart rate before surgery, 1, 10 and 20 minutes postoperatively were recorded. Pain was measured before, 6, 12 and 24 hours after surgery. Data analysis was performed using SPSS software version 21 and using descriptive and inferential statistical tests.
Results: Ibuprofen and ketorolac groups were similar in terms of gender, age, BMI and ASA. The results of Mann-Whitney test showed that there was a significant difference between ibuprofen and ketorolac groups in terms of pain at 6 hours postoperatively (p <0.05). At 6 hours postoperatively, the mean pain in patients in the ibuprofen group was higher than in the ketorolac group. Also, the results of Friedman test showed that the pain trend was significant in the ketorolac and ibuprofen groups (p <0.05).
Conclusion: Based on the results of the present study, injection of 30 mg intravenous ketorolac had more pain relief than 400 mg ibuprofen during the study, especially in the first 6 hours after surgery among patients undergoing upper limb orthopedic surgery. 
Keywords
Intravenous Ibuprofen
Ketorolac
Pain
Orthopedics
Upper limb
  1. Echeverria-Villalobos M, Stoicea N, Todeschini AB, Fiorda-Diaz J, Uribe AA, Weaver T, Bergese SD. Enhanced
    recovery after surgery (ERAS): A perspective review of postoperative pain management under ERAS pathways and
    its role on opioid crisis in the United States. The Clinical journal of pain. 2020 Mar 10;36(3):219-26.
    2. Lindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. International journal
    of colorectal disease. 2020 Jul;35:1265-72.
    3. Vahabi S, Karimi A, Beiranvand S, Moradkhani M, Hassanvand K. Comparison of the effect of different dosages of
    celecoxib on reducing pain after cystocele and rectocele repair surgery. The Open Anesthesia Journal. 2020 Jun
    15;14(1).
    4. Rahmani M, Bahraminejad N, Rezaei M. The effect of family-oriented educational intervention on postoperative
    pain after orthopedic surgery. Iranian journal of nursing and midwifery research. 2020 Jan;25(1):47.
    5. Ekinci M, Ciftci B, Celik EC, Köse EA, Karakaya MA, Ozdenkaya Y. A randomized, placebo-controlled, doubleblind study that evaluates efficacy of intravenous ibuprofen and acetaminophen for postoperative pain treatment
    following laparoscopic cholecystectomy surgery. Journal of Gastrointestinal Surgery. 2020 Apr;24(4):780-5.
    6. Can Ö, Kıyan GS, Yalçınlı S. Comparison of intravenous ibuprofen and paracetamol in the treatment of fever: A
    randomized double-blind study. The American Journal of Emergency Medicine. 2021 Aug 1;46:102-6.
    7. Patel NK, Shah SJ, Lee NK, Gao Q, Carullo VP, Yang CJ. Intraoperative intravenous ibuprofen use is not associated
    with increased post-tonsillectomy bleeding. International journal of pediatric otorhinolaryngology. 2020 Jun
    1;133:109965.
  2. 8. Kim SY, Lee S, Lee Y, Kim H, Kim KM. Effect of single dose preoperative intravenous ibuprofen on postoperative
    pain and opioid consumption: a systematic review and meta-analysis. Korean Journal of Anesthesiology. 2021 Feb
    22.
    9. Yalçınlı S, Kıyan GS, Can Ö. Comparison of intravenous ibuprofen and paracetamol efficiency in soft tissue injuries:
    A randomized, double-blind study. The American Journal of Emergency Medicine. 2020 Oct 1;38(10):2014-8.
    10. Weisz RD, Fokin AA, Lerner V, Flynt A, Macias-Perez I, Pavliv L, Crawford M, Puente I. Intravenous Ibuprofen
    Reduces Opioid Consumption During the Initial 48 Hours After Injury in Orthopedic Trauma Patients. Journal of
    orthopaedic trauma. 2020 Jul;34(7):341.
    11. Dwarica DS, Pickett SD, Zhao YD, Nihira MA, Quiroz LH. Comparing ketorolac with ibuprofen for postoperative
    pain: a randomized clinical trial. Female pelvic medicine & reconstructive surgery. 2020 Apr 1;26(4):233-8.
    12. Lee HM, Park JH, Park SJ, Choi H, Lee JR. Comparison of Monotherapy Versus Combination of Intravenous
    Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children
    Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial. Anesthesia and Analgesia.
    2020 Nov 10.
    13. Southworth SR, Sellers JA. Narrative Summary of Recently Published Literature on Intravenous Ibuprofen. Clinical
    Therapeutics. 2020 Jun 3.
    14. Elkhouly AT, Bassiony MA, Elshafey MM, Khalaf KM, Alansary AM. Comparative study between: Epidural
    bupivacaine versus Patient Controlled Analgesia for postoperative pain control in total knee arthroplasty. QJM: An
    International Journal of Medicine. 2020 Mar 1;113(Supplement_1):hcaa039-073.
    15. Ciftci B, Ekinci M, Atalay YO. Ultrasound guided rhomboid intercostal block provides effective pain control after
    video-assisted thoracoscopic surgery: a brief report of three cases. Korean Journal of Anesthesiology. 2020 Nov 17.
    16. Wan RJ, Liu SF, Kuang ZP, Ran Q, Zhao C, Huang W. Influence of Ketorolac Supplementation on Pain Control for
    Knee Arthroscopy: A Meta‐Analysis of Randomized Controlled Trials. Orthopaedic surgery. 2020 Feb;12(1):31-7.
    17. Lee JK, Kang C, Hwang DS, Lee GS, Hwang JM, Park EJ, Ga IH. An Innovative Pain Control Method Using
    Peripheral Nerve Block and Patient-Controlled Analgesia With Ketorolac After Bone Surgery in the Ankle Area: A
    Prospective Study. The Journal of Foot and Ankle Surgery. 2020 Jul 1;59(4):698-703.
    18. Laoruengthana A, Rattanaprichavej P, Mahatthanatrakul A, Tantimethanon T, Lohitnavy M, Pongpirul K.
    Periarticular Injection of Ketorolac Augmenting Intravenous Administration of Ketorolac for Postoperative Pain
    Control: A Randomized Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty. The Journal of Knee
    Surgery. 2020 Nov 23.
    19. Chobpenthai T, Ingviya T, Thanindratarn P, Jaiwithee R, Sutthivaiyakit K. Ketorolac plus Lidocaine vs Lidocaine
    for pain relief following core needle soft tissue biopsy: A CONSORT-compliant double-blind randomized controlled
    study. Medicine. 2021 Feb 19;100(7).
    20. Rao R, Jackson RS, Rosen B, Brenin D, Cornett W, Fayanju OM, Chen SL, Golesorkhi N, Ludwig K, Ma A, Mautner
    SK. Pain control in breast surgery: survey of current practice and recommendations for optimizing management—
    American Society of Breast Surgeons Opioid/Pain Control Workgroup. Annals of surgical oncology. 2020
    Apr;27(4):985-90.
    21. Pace V, Gul A, Prakash V, Park C, Placella G, Raine G. Wound Infiltration with Levobupivacaine, Ketorolac, and
    Adrenaline for Postoperative Pain Control after Spinal Fusion Surgery. Asian Spine Journal. 2020 Sep 3.
    22. Dwarica DS, Pickett SD, Zhao YD, Nihira MA, Quiroz LH. Comparing ketorolac with ibuprofen for postoperative
    pain: a randomized clinical trial. Female pelvic medicine & reconstructive surgery. 2020 Apr 1;26(4):233-8.
    23. Chobpenthai T, Ingviya T, Thanindratarn P, Jaiwithee R, Sutthivaiyakit K. Ketorolac plus Lidocaine vs Lidocaine
    for pain relief following core needle soft tissue biopsy: A CONSORT-compliant double-blind randomized controlled
    study. Medicine. 2021 Feb 19;100(7).
    24. Singhatanadgige W, Chancharoenchai T, Honsawek S, Kotheeranurak V, Tanavalee C, Limthongkul W. No
    Difference in Pain After Spine Surgery with Local Wound Filtration of Morphine and Ketorolac: A Randomized
    Controlled Trial. Clinical Orthopaedics and Related Research®. 2020 Dec 1;478(12):2823-9.
    25. Owezarzak V, Haddad J (2006) Comparison of oral versus rectal administration of acetaminophen with codeine in
    postoperative pediatric adenotonsillectomy patients. Laryngoscope 116:1485–1488
    26. Pickering AE, Dridge HS, Nolan J, Stoddart PA (2002) Double-blin placebocontrolled analgesic study of ibuprofen
    or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth 88:72–77
    27. Svensson CI, Yaksh TL. The spinal phospholipasecyclooxygenase- prostanoid cascade in nociceptive processing.
    Annu Rev Pharmacol Toxicol. 2002;42:553–583.
  3. 28. Warner TD, Giuliano F, Vojnovic I, Bukasa A, Mitchell JA, Vane JR. Nonsteroid drug selectivities for cyclooxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro
    analysis. Proc. Natl Acad. Sci. USA 96(13), 7563–7568 (1999).
    29. Ketorolac tromethamine, prescribing information. Bedford Laboratories, OH, USA (2009).
    30. Kroll PB, Meadows L, Rock A, Pavliv L. A multicenter, randomized, doubleblind, placebo-controlled trial of
    intravenous ibuprofen (i.v.-ibuprofen) in the management of postoperative pain following abdominal hysterectomy.
    Pain Pract. (2011) 11:23–32. doi: 10.1111/j.1533-2500.2010.00402.x
    31. Cenker E, Serinken M, Uyanik E. Intravenous paracetamol vs ibuprofen in renal colic: a randomised, double-blind,
    controlled clinical trial. Urolithiasis. 2018;46(4):369–73. doi: 10.1007/s00240-017-0997-7. [PubMed: 28681267].
    32. Clarc E, Plint AC, Correl R, Gaboury I, Passi B. A randomaized, controlled trial of acetaminophen, ibuprofen, and
    codeine for acute pain relief in children with musculoskeletal trauma. Pediateris. 2007;119(3):460-7. PMID:
    17332198 DOI: 10.1542/peds.2006-1347
    33. Fragen RJ, Stulberg SD, Wixson R, Glisson S, Librojo E. Effect of ketorolac tromethamine on bleeding and on
    requirements for analgesia after total knee arthroplasty. J Bone Joint Surg Am. (1995) 77:998–1002. doi:
    10.2106/00004623-199507000-00004
    34. Cassinelli EH, Dean CL, Garcia RM, Furey CG, Bohlman HH. Ketorolac use for postoperative pain management
    following lumbar decompression surgery: a prospective, randomized double-blinded, placebo-controlled trial.
    Spine(Philla Pa 1976). 2008 May 20;33(12):1313–7. [PubMed] doi: 10.1097/BRS.0b013e31817329bd.
    35. Waleed MA, Hesham FS,Mohamed AF.Preemptive intravenous ketorolac dose not alter bleeding after tonsillectomy
    in children.Ain-Shams Journal of Anesthesiology.2015,08:43-9.
    36. Uribe AA, Arbona FL, Flanigan DC, Kaeding CC, Palettas M, Bergese SD. Comparing the efficacy of IV ibuprofen
    and ketorolac in the management of postoperative pain following arthroscopic knee surgery. A randomized doubleblind active comparator pilot study. Frontiers in surgery. 2018 Oct 3;5:59.
    37. Haddadian A, Poormotaabed S, Nasiri Gigloo K, Ghorbani AmjadG, Bahrami A. Comparison of Ketorolac and
    Ibuprofen IV Infusion Effect on Radius Distal Fracture Pain Control.Avicenna J Clin Med. 2018; 25(2): 79-84. DOI:
    10.21859/ ajcm.25.2.79
    38. Pinzon RT, Susanto FE. EFFECTIVENESS OF INTRAVENOUS IBUPROFEN COMPARED TO
    INTRAVENOUS KETOROLAC FOR IMPROVING THE SLEEP QUALITY PATIENTS OF ACUTE NONSPECIFIC MUSCULOSKELETAL PAINS. Romanian Journal of Neurology. 2020 Jul 1;19(3).
    39. Forouzanfar MM, Mohammadi K, Hashemi B, Safari S. Comparison of intravenous ibuprofen with intravenous
    ketorolac in renal colic pain management; A clinical trial. Anesthesiology and pain medicine. 2019 Feb;9(1).
    40. Bushra R, Aslam N. An Overview of Clinical Pharmacology of Ibuprofen. Oman Med J. 2010;25.
Medical Journal of Mashhad university of Medical Sciences
Volume 64, Issue 2
July and August 2021
Pages 2692-2705