Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparison of Analgesic Effects of Paracetamol and Ibuprofen After Laparoscopic Cholecystectomy
Laparoskopik Kolesistektomi Sonrası Parasetamol ve İbuprofenin Postoperatif Analjezik Etkilerinin Karşılaştırılması
Öznur DEMİROLUKa, Süheyla ABİTAĞAOĞLUa, Dilara KARACA GÖÇMENa, Yetkin ÖZCABIb, Dilek ERDOĞAN ARIa
Departments of
aAnesthesiology and Reanimation,
bGeneral Surgery, University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(3):278-84
doi: 10.5336/medsci.2018-63679
Article Language: EN
Full Text
ABSTRACT
Objective: Non-steroid anti-inflammatory drugs (NSAIDs) and paracetamol (P) are frequent constituents of multimodal postoperative analgesia. The aim of this study was to compare analgesic effects of intravenous (IV) paracetamol and ibuprofen (IB) administered intraoperatively and in repeated doses postoperatively to the patients who underwent laparoscopic cholecystectomy. Material and Methods: A total of 40 patients with class of American Society of Anesthesiologists (ASA) I-III who underwent laparoscopic cholecystectomy were randomized into Groups-P and IB in this randomized, prospective and double-blind study. After anesthesia induction and initiation of the surgery, Group-P patients received 1 g IV paracetamol and Group-IB patients received 800 mg IV ibuprofen. At skin closure, 1.5 mg/kg of IV tramadol was administered. For postoperative analgesia, a patient-controlled analgesia (PCA) pump with tramadol was used. During the first 24h postoperatively, Group-P patients received 1 g of IV paracetamol and Group-IB patients received 400 mg of IV ibuprofen at every 6h. Patients with visual analog pain scale (VAS) scores ≥ 4 received rescue analgesia. The groups were compared for postoperative first 24h VAS scores, PCA demand, total tramadol dose, and rescue analgesic requirement. Results: Compared with Group-P, Group-IB had significantly lower VAS-awakening, VAS-post-anesthesia care unit (PACU) and VAS- 6th h scores. Postoperative rescue analgesic requirement was lower in Group-IB than in Group-P at all timepoints, most notably in the PACU. Conclusion: Compared with paracetamol, intraoperative and repeated postoperative doses of ibuprofen substantially decreased the pain scores and rescue analgesic requirement. As a component of multimodal analgesia, IV ibuprofen is an effective option for postoperative pain management.

Keywords: Ibuprofen; postoperative pain; analgesia; laparoscopic cholecystectomy; paracetamol
ÖZET
Amaç: Non-steroid anti-inflamatuar ilaçlar (NSAİİ) ve parasetamol multimodal postoperatif ağrı tedavisinde sıklıkla kullanılan ilaçlardır. Bu çalışmanın amacı, laparoskopik kolesistektomi operasyonu geçiren hastalarda intraoperatif ve postoperatif dönemde tekrarlanan dozlarda uygulanan intravenöz (IV) parasetamol ve ibuprofen'in analjezik etkilerinin karşılaştırılmasıdır. Gereç ve Yöntemler: Randomize, prospektif, çift-kör olan bu çalışmada laparoskopik kolesistektomi geçiren ASAI-III toplam 40 hasta Grup-P ve Grup-IB olarak randomize edildi. Anestezi indüksiyonu sonrası cerrahi başlangıcında Grup-P'deki hastalara 1 g parasetamol ve Grup-IB'deki hastalara 800 mg ibuprofen IV olarak uygulandı. Cilt sutürlerine geçildiğinde 1,5 mg/kg IV tramadol verildi. Postoperatif analjezide tramadol ile hazırlanmış hasta kontrollü analjezi cihazı (HKA) kullanıldı. Postoperatif ilk 24 saat boyunca Grup-P'deki hastalara 1gr parasetamol, Grup-IB'deki hastalara 400mg ibuprofen 6 saat arayla IV olarak uygulandı. VAS skorları ≥ 4 olan hastalara kurtarıcı analjezik uygulandı. Gruplar postoperatif ilk 24 saat VAS skorları, HKA kullanım miktarı, toplam tramadol miktarı, kurtarıcı analjezik gereksinimi açısından karşılaştırıldı. Bulgular: Grup-P ile karşılaştırıldığında Grup-IB'de VAS- uyanma, VAS-anestezi sonrası bakım ünitesi ve VAS-6.saat değerleri belirgin olarak düşüktü. Postoperatif kurtarıcı analjezik gereksinimi özellikle anestezi sonrası bakım ünitesinde olmak üzere tüm dönemlerde anlamlı olarak düşüktü. Sonuç: Parasetamol ile karşılaştırıldığında intraoperatif ve postoperatif tekrarlayan dozlarda IV ibuprofen uygulaması, postoperatif dönemde ağrı skorlarını ve kurtarıcı analjezik gereksinimini belirgin olarak düşürmektedir. Multimodal analjezinin bir parçası olarak IV ibuprofen postoperatif ağrı tedavisinde etkili bir analjezik seçeneğidir.

Anahtar Kelimeler: İbuprofen; postoperatif ağrı; analjezi; laparoskopik kolesistektomi; parasetamol
REFERENCES:
  1. Argoff CE. Recent management advances in acute postoperativepain. Pain Pract. 2014; 14(5):477-87.
  2. Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci. 2015;22(6):930-8. [Crossref]  [PubMed] 
  3. Tighe P, Buckenmaier CC 3rd, Boezaart AP, Carr DB, Clark LL, Herring AA, et al. Acute pain medicine in the United States: a status report. Pain Med. 2015;16(9):1806-26. [Crossref]  [PubMed]  [PMC] 
  4. Gupta A, Abubaker H, Demas E, Ahrendtsen L. A randomized trial comparing the safety and efficacy of intravenous ibuprofen versus ibuprofen and acetaminophen in knee or hip arthroplasty. Pain Physician. 2016;19(6):349-56.
  5. Koh W, Nguyen KP, Jahr JS. Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesthesiol. 2015;68(1):3-12. [Crossref]  [PubMed]  [PMC] 
  6. Kaye AD, Ali SI, Urman RD. Perioperative analgesia: ever-changing technology and pharmacology. Best Pract Res Clin Anaesthesiol. 2014;28(1):3-14. [Crossref]  [PubMed] 
  7. Pitchon DN, Dayan AC, Schwenk ES, Baratta JL, Viscusi ER. Updates on multimodal analgesia for orthopedic surgery. Anesthesiol Clin. 2018;36(3):361-73. [Crossref]  [PubMed] 
  8. Protic M, Veljkovic R, Bilchik AJ, Popovic A, Kresoja M, Nissan A, et al. Prospective randomized controlled trial comparing standard analgesia with combined intra-operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy. Surg Endosc. 2017;31(2):704-13. [Crossref]  [PubMed] 
  9. Hassler KR, Jones MW. Gallbladder, Cholecystectomy, Laparoscopic. Treasure Island (FL): Stat Pearls Publishing; 2017.
  10. Sjövall S, Kokki M, Kokki H. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management. Drugs. 2015;75(16): 1867-89. [Crossref]  [PubMed] 
  11. Saadati K, Razavi MR, Nazemi Salman D, Izadi S. Postoperative pain relief after laparoscopic cholecystectomy: intraperitoneal sodium bicarbonate versus normal saline. Gastroenterol Hepatol Bed Bench. 2016;9(3):189-96.
  12. Bandey S, Singh V. Comparison between IV paracetamol and tramadol for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. J Clin Diagn Res. 2016;10(8):UC05-9. [Crossref]  [PubMed]  [PMC] 
  13. Salihoglu Z, Yildirim M, Demiroluk S, Kaya G, Karatas A, Ertem M, et al. Evaluation of intravenous paracetamol administration on postoperative pain and recovery characteristics in patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2009;19(4):321-3. [Crossref]  [PubMed] 
  14. El-Radaideh K, Alhowary A, Hani DB, Bataineh A, Hani MB. Analgesic efficacy of intravenous paracetamol plus tramadol combination for pain after laparoscopic cholecystectomy: a double-blind, randomized, placebo controlled trial. Analg Resusc Curr Res. 2014;3:3.
  15. Jawad M, Jebur MA. A comparative study of intravenous paracetamol and tramadol for postoperative pain management in patients undergoing laparoscopic cholecystectomy. Med J Babylon. 2014;11(2):335-42.
  16. Derry S, Cooper TE, Phillips T. Single fixed-dose oral dexketoprofen plus tramadol for acute postoperative pain in adults. Cochrane Database Syst Rev. 2016;9:CD012232. [Crossref]  [PMC] 
  17. Ahiskalioglu EO, Ahiskalioglu A, Aydin P, Yayik AM, Temiz A. Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine (Baltimore). 2017;96(8):e6200. [Crossref]  [PubMed]  [PMC] 
  18. Karaca O, Pınar HU, Turk E, Dogan R, Ahiskalioğlu A, Solak SK. Effects of single-dose preemptive pregabalin and intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. J Invest Surg. 2017;1-7. [Crossref]  [PubMed] 
  19. Scott LJ. Intravenous ibuprofen: in adults for pain and fever. Drugs. 2012;72(8):1099-109. [Crossref]  [PubMed] 
  20. Southworth S, Peters J, Rock A, Pavliv L. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen 400 and 800 mg every 6 hours in the management of postoperative pain. Clin Ther. 2009;31(9):1922-35. [Crossref]  [PubMed] 
  21. Liu X, Wang X, Zhao W, Wei L, Zhang P, Han F. A prospective, randomized, double-blind, placebo-controlled trial of acute postoperative pain treatment using opioid analgesics with intravenous ibuprofen after radical cervical cancer surgery. Sci Rep. 2018;8(1):10161. [Crossref]  [PubMed]  [PMC] 
  22. Gago Martínez A, Escontrela Rodriguez B, Planas Roca A, Martínez Ruiz A. Intravenous ibuprofen for treatment of post-operative pain: a multicenter, double blind, placebo-controlled, randomized clinical trial. PloS One. 2016;11(5):e154004. [Crossref]  [PubMed]  [PMC] 
  23. Paul D, Jacob M, Kulkarni SN. Comparative evaluation of efficacy of intravenous paracetamol and intravenous diclofenac as post-operative analgesia in laparoscopic cholecystectomy. Int J Biomed Res. 2015;6(07):482-7. [Crossref] 
  24. Alhashemi JA, Alotaibi QA, Mashaat MS, Kaid TM, Mujallid RH, Kaki AM. Intravenous acetaminophen vs oral ibuprofen in combination with morphine PCIA after cesarean delivery. Can J Anaesth. 2006;53(12):1200-6. [Crossref]  [PubMed] 
  25. Cenker E, Serinken M, Uyanık E. Intravenous paracetamol vs ibuprofen in renal colic: a randomised, double-blind, controlled clinical trial. Urolithiasis. 2017;46(4):369-73. [Crossref]  [PubMed] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com