Preemptive Analgesia with Nonsteroidal Anti-Inflammatory Drugs in the Perioperative Period

Abstract

Objective. A comparative assessment of the efficacy and safety of the preemptive use of ibuprofen and ketoprofen in patients undergoing elective surgery under general anesthesia.Material and methods. A multicenter randomized prospective study included 58 patients grouped into 2 arms. Ibuprofen 800 mg in Group 1 (N=32), and ketoprofen 100 mg in Group 2 (N=26) were administered intravenously 30 minutes prior to surgical procedure, and afterwards every 12 hours during patient’s stay in the intensive care unit. Efficacy and safety were assessed using a visual analog scale (VAS), patient’s need in opioid analgesics, laboratory parameters (serum levels of cortisol, cystatin C, CBC, coagulogram, TEG) and instrumental methods (algesimetry — qNOX).Results. VAS values were 32.4% lower in Group 1 vs Group 2 in the immediate postoperative period, P=0.003. By the end of Day 1 this difference was no longer visible following the use of promedol. There was a correlation between qNOX values at the end of surgery and VAS values at patient’s waking up from anesthesia (P=0.0007). Cortisol plasma concentrations in groups 1 and 2 did not differ significantly, P=0.105. The average daily promedol consumption in Groups 1 and 2 was 42±17.5 mg/day and 50±19.7 mg/day, respectively, P=0.022. Cystatin C concentrations in the first morning after surgery was 0.95±0.29 mg/l in the ibuprofen group, and 1.19±0.43 mg/l — in the ketoprofen group, P=0.027. Signs of renal dysfunction were documented in 4 out of 32 patients (12, 5%) from Group 1, and in 10 of 26 (38.5%) patients from Group 2 since the end of surgery and up to the first postop morning, the Chi-squared value was 0.031. Hemostasis was not affected by NSAIDs use in both groups.Conclusion. Ibuprofen provided more powerful analgesia, than ketoprofen in the postoperative period, while during surgical procedure both drugs showed similar anlgesic efficacy. Patients on ibuprofen required significantly fewer additional boluses of opioid analgesics. Both drugs showed no clinically significant effect on hemostasis and hematopoiesis. More rare occurrence of renal dysfunction in Group 1 patients is indicative of lower nephrotoxicity of ibuprofen.

Keywords

• preemptive analgesia
• anesthesia
• nonsteroidal anti-inflammatory drugs
• nsaids
• ibuprofen
• ketoprofen
• perioperative period
• automated monitoring of sedation
• icu