Key result
IV ibuprofen reduces 24-hour postoperative morphine consumption by ~24% versus placebo.
Why the study?
While the recommended intravenous ibuprofen dose in the USA and Europe is 800 mg every 6 hours, it was unknown whether 800 mg is needed in the Chinese population.
Does intravenous ibuprofen 400 mg or 800 mg reduce postoperative morphine consumption in adult patients undergoing abdominal or orthopedic surgery?
RCT (n=396)
Double-blind
Computer-generated random number sequence
Yes
Does intravenous ibuprofen 400 mg or 800 mg reduce postoperative morphine consumption in adult patients undergoing abdominal or orthopedic surgery?
Absolute Event Rate: 29.8% vs 39.1%
p-value: p=<0.001
Intravenous ibuprofen at 400 mg is as effective as the recommended 800 mg dose in reducing postoperative morphine consumption in a Chinese population.
Background: Multimodal postoperative analgesia with intravenous ibuprofen can reduce the consumption of opioids and reduce the postoperative pain intensity. Recommended dose in the USA and Europe is 800 mg every 6 hours for the management of moderate to severe postoperative pain. The purpose of this study was to investigate whether 800 mg is needed in the Chinese population.Methods: This is a multicenter, randomized, controlled multi-center trial. Adult patients (18-65 years of age) scheduled for abdominal or orthopedic surgery under general anesthesia with endotracheal intubation were eligible. Subjects were randomized at a ratio of 1:1:1 to receive ibuprofen at 400 or 800 mg or saline every 6 hours for 48 hours after the operation. All subjects received morphine access through patient-controlled intravenous analgesia (PCIA) device, which was set as background infusion rate 0.5 mg/h, bolus 1 mg, 5-minute lock interval and 20-mg 4-hour limit. The primary endpoint was morphine consumption within the first 24 hours after surgery. Results: A total of 396 patients were enrolled (180 men, 216 women; 46±12.4 years of age; 106 patients receiving abdominal surgery, and 290 patients receiving orthopedic surgery). The number of patients was 131 in the placebo group, 132 in the 400-mg group, and 133 in the 800-mg group. The 3 groups did not differ in age, sex, BMI and the type of surgery. Median 24-hour morphine consumption was 39.1 mg (IQR: 29.7, 61.7) mg in the placebo control, 29.8 mg (IQR: 24.3, 43.7) mg in the 400-mg group, and 28.0 mg (IQR: 24.1, 35.9) in the 800-mg group (P<0.001 for comparisons between placebo versus 400 and 800 mg ibuprofen). There was no significant difference between the two ibuprofen groups (P=0.125). Analgesia-related adverse events did not differ among the 3 groups.Conclusions: Intravenous ibuprofen at either 400 or 800 mg every 6 hours could reduce postoperative morphine consumption, with apparently equal efficacy in Chinese population.
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Zhang et al. (2021) conducted an RCT in Postoperative pain (n=396). Intravenous Ibuprofen vs. Placebo (saline) was evaluated on Morphine consumption within the first 24 hours after surgery (p=<0.001). Intravenous ibuprofen at either 400 mg or 800 mg every 6 hours significantly reduced median 24-hour postoperative morphine consumption compared to placebo (29.8 mg and 28.0 mg vs 39.1 mg, p<0.001).
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