Key result
The combination of paracetamol and ibuprofen reduced rest pain scores at 6 hours postoperatively compared to ibuprofen in patients undergoing Cesarean section.
Why the study?
The study aimed to compare the combination of paracetamol with various doses of ibuprofen as multimodal analgesia in C-section surgery patients under spinal anesthesia.
Does the combination of 750 mg paracetamol and 800 mg ibuprofen improve pain control and inflammatory profiles in Cesarean section patients compared to lower doses of ibuprofen?
RCT (n=60)
Single-blind
Randomized
Yes
Does the combination of 750 mg paracetamol and 800 mg ibuprofen improve pain control and inflammatory profiles in Cesarean section patients compared to lower doses of ibuprofen?
The combination of 750 mg IV paracetamol and 800 mg IV ibuprofen provides superior post-operative pain relief, reduces inflammatory markers, and eliminates the need for rescue fentanyl compared to lower ibuprofen doses in C-section patients.
Answers are grounded in this paper and cite their sources.
Supports multimodal analgesia with paracetamol-ibuprofen combo after cesarean; extends RCT evidence beyond ibuprofen monotherapy for pain and inflammation.
AIM: This single-blind study aimed to compare the combination of paracetamol with various doses of ibuprofen as multimodal analgesia in C-section surgery patients under spinal anesthesia. Levels of interleukin (IL)-6 and C-reactive protein (CRP) were analyzed as markers of inflammation. METHODS: Treatment groups (20 patients each) were: Group A, 750 mg paracetamol and 400 mg ibuprofen; Group B, 750 mg paracetamol and 600 mg ibuprofen; and Group C, 750 mg paracetamol and 800 mg ibuprofen. Degree of pain (movement and rest), scored using the numeric rating scale (NRS) and levels of IL-6 and CRP were assessed at various time points within 24 h of surgery. Side effects and numbers of subjects requiring rescue fentanyl administration were also recorded. RESULTS: Group C showed a rest NRS score of 1.00 ± 0.00 6 h postoperatively, compared with 2.00 ± 0.00 in Group B and 2.35 ± 0.87 in Group A. 4 h postoperatively, movement NRS scores were 1.00 ± 0.00 for Group C, compared to 3.00 ± 1.77 for Group B, and 4.85 ± 1.81 for Group A. At 12 h, IL-6 levels hours were 2.66 ± 0.04 pg/mL for Group A, 2.39 ± 0.02 pg/mL for Group B, and 2.05 ± 0.01 pg/mL for Group C. At 6 h, CRP levels were 1.18 ± 0.04 mg/L for Group A, 0.95 ± 0.01 mg/L for Group B, and 0.70 ± 0.02 mg/L for Group C. Overall, Group C showed the lowest values for all parameters analyzed, compared with other groups, and the differences were significant (p < 0.05). In addition, none of the patients in Group C required rescue fentanyl (p < 0.05), and no patients in any of the groups showed any side effects. CONCLUSION: For pain management after C-section surgery, the combination of 750 mg paracetamol and 800 mg ibuprofen yielded the best results as assessed by NRS scores, levels of IL-6 and CRP, and fentanyl rescue.
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Gaus et al. (2023) conducted an RCT in Cesarean section (n=60). Paracetamol and Ibuprofen 800 mg vs. 750 mg IV paracetamol + 400 mg or 600 mg IV ibuprofen was evaluated on Rest pain numeric rating scale (NRS) score at 6 hours postoperatively (p=0.001). The combination of paracetamol and ibuprofen reduced rest pain scores at 6 hours postoperatively compared to ibuprofen in patients undergoing Cesarean section.
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