Intravenous ibuprofen appears to offer no analgesic or bleeding-related benefit over intravenous ketorolac in elective primary or repeat Caesarean delivery, according to a study presented here at ANESTHESIOLOGY 2015, the Annual Meeting of the American Society of Anesthesiologists (ASA).
“We expected less bleeding with ibuprofen than ketorolac based on the degree to which each drug inhibits [cyclooxygenase] -1 and -2,” said lead investigator Dmitri Chamchad, MD, Lankenau Institute of Medical Research, Wynnewood, Pennsylvania. “However, we saw no signal of a clinically relevant difference in bleeding.”
The peripheral anti-inflammatory effects of intravenous non-steroidal anti-inflammatory drugs (NSAIDs) may augment their analgesic effects. Over the last 10 years intravenous ibuprofen has become almost as commonly used as intravenous ketorolac.
Although controlled studies have documented the efficacy and safety of intravenous ibuprofen, ketorolac and ibuprofen differ in their inhibitory effects on cyclooxygenase (COX) isoforms 1, 2, and 3. Also, there are concerns about neonatal NSAID exposure via breastfeeding, which has led some caregivers to avoid giving ketorolac altogether after C-section.
Dr. Chamchad and colleagues hypothesised that patients undergoing elective primary or repeat C-section who received postoperative intravenous ibuprofen would need less rescue analgesia than those receiving intravenous ketorolac.
The researchers randomised 48 women scheduled for elective primary or repeat C-sections to 4 intravenous doses of either ibuprofen 800 mg or ketorolac 30 mg every 6 hours beginning just after C-section conducted with subarachnoid bupivacaine 12.5 mg, fentanyl 10 mcg, and morphine 0.2 mg, and no other intra-operative analgesic.
There was no difference between the groups in preoperative, postoperative, or perioperative decreases in haemoglobin or haematocrit values. There was also no difference in perioperative fluid administration, and no patient received a transfusion.
The groups also showed a similar number of patient-controlled analgesia requests and hydromorphone doses.
There were no adverse effects of any kind during the study period, including allergic reactions or gastrointestinal ulcers or perforations.
Dr. Chamchad said the current results point to a low likelihood of a larger cohort demonstrating superiority of ibuprofen. However, they are planning to compare intravenous acetaminophen to intravenous ketorolac in a similar setting.
[Presentation title: A Randomized Double-blind Comparison of IV Ibuprofen vs IV Ketorolac to Prevent Postoperative Pain After Elective Cesarean Section. Abstract A3110]