Early Postoperative Analgesic Outcomes Following Pre-Induction Intravenous Ibuprofen in Children Undergoing Hypospadias Repair: A Randomized Controlled Study

Background: Hypospadias repair is a pediatric surgical procedure associated with relatively pronounced postoperative pain. However, evidence guiding procedure-specific perioperative analgesic strategies remains limited. Although preoperative intravenous ibuprofen has demonstrated analgesic benefits in other pediatric surgical settings, data specific to pediatric urological surgery are scarce. Methods: In this randomized, double-blind, placebo-controlled trial, 104 children (2–7 years old, American Society of Anesthesiologists ASA physical status I–II) scheduled for urethroplasty were randomized to receive either intravenous ibuprofen (10 mg/kg; Group I) or saline (Group C) before anesthesia induction. The primary outcome was the proportion of patients requiring rescue opioid analgesia in the postanesthesia care unit (PACU). Secondary outcomes included postoperative FLACC (Face, Legs, Activity, Cry, Consolability), NRS-11 (the numerical rating scale-11 scale), and PAED (Pediatric Anesthesia Emergence Delirium) scores, repeated rescue analgesia, intraoperative opioid use, the LMA (laryngeal mask airway) removal time, and adverse events. Results: Ninety-three patients completed the study (Group I, n = 47; Group C, n = 46). The proportion of patients requiring rescue analgesia in the PACU was significantly lower in the ibuprofen group than in the control group (12.77% vs. 30.43%, p = 0.038, 95% CI: 0.116, 0.968). Moderate-to-severe pain (FLACC ≥ 4) in the PACU occurred less frequently in the ibuprofen group, whereas incidence of emergence delirium was similar between groups. No significant differences were observed in the pain scores on postoperative days 1 and 2, intraoperative opioid use, the LMA removal time, or adverse events. Conclusions: Pre-induction intravenous ibuprofen reduced early postoperative rescue analgesia requirements without increasing adverse events in children undergoing hypospadias repair.