Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T06:54:03.848Z Has data issue: false hasContentIssue false
  • English
  • Français

Ibuprofen vs. acetaminophen vs. ibuprofen and acetaminophen after arthroscopically assisted anterior cruciate ligament reconstruction

Published online by Cambridge University Press:  23 December 2004

V. Dahl ,
T. Dybvik ,
T. Steen ,
A. K. Aune ,
E. K. Rosenlund  and
J. C. Ræder
V. Dahl
Affiliation:
Volvat Medical Centre, Department of Anesthesia, Oslo, Norway
T. Dybvik
Affiliation:
Volvat Medical Centre, Department of Anesthesia, Oslo, Norway
T. Steen
Affiliation:
Volvat Medical Centre, Department of Orthopedic Surgery, Oslo, Norway
A. K. Aune
Affiliation:
Volvat Medical Centre, Department of Orthopedic Surgery, Oslo, Norway
E. K. Rosenlund
Affiliation:
Volvat Medical Centre, Department of Orthopedic Surgery, Oslo, Norway
J. C. Ræder
Affiliation:
Volvat Medical Centre, Department of Anesthesia, Oslo, Norway
Get access

Abstract

Summary

Background and objective: The analgesic potency of non-steroidal anti-inflammatory drugs and acetaminophen are still being debated. We have assessed the relative analgesic effect of ibuprofen, acetaminophen or the combination of both after orthopaedic surgery.

Methods: Sixty-one ASA I patients, scheduled for an elective anterior cruciate ligament reconstruction under general anaesthesia were randomized, in a double blind fashion, into one of three groups. The ibuprofen group (n = 17) received ibuprofen 800 mg orally 1 h before operation and again at 6 and 12 h after the initial dose. The acetaminophen group (n = 20) received of acetaminophen 1 g orally at the same time intervals. The combination group (n = 24) received both ibuprofen 800 mg and acetaminophen 1 g. Surgery was performed under general anaesthesia with propofol and fentanyl for induction and maintenance with propofol and nitrous oxide in oxygen. The patients were monitored for 24 h thereafter, and the following variables were assessed: pain by visual analogue and verbal scales, need for rescue intravenous opioid analgesia (i.e. ketobemidone) and adverse events.

Results: The ibuprofen group and the combination group experienced significantly less pain during the first 6 h after surgery than the acetaminophen group using the visual analogue and the verbal scales. The acetaminophen group also had a significantly higher average consumption of opioids during the first 6 and 24 h. There were no significant differences between the ibuprofen group and the combination group in respect of experienced pain or consumption of rescue analgesia. The incidence of side-effects, postoperative haemoglobin concentration and renal function, judged by creatinine clearance, were identical between the groups.

Conclusion: Ibuprofen 800 mg thrice daily reduced pain to a greater degree than acetaminophen 1 g thrice daily, after anterior cruciate ligament reconstruction under general anaesthesia. The combination of acetaminophen and ibuprofen did not provide any superior analgesic effect.

Keywords

ANALGESICS, NON-NARCOTIC, acetaminophenANALGESICS, NON-NARCOTIC, anti-inflammatory agents, non-steroidal, ibuprofenENZYME INHIBITORS, cyclo-oxygenase inhibitorsPAIN, pain, postoperative
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 471 - 475
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Dahl JB, Kehlet H. Non-steroidal anti-inflammatory drugs: rationale for use in severe postoperative pain. Br J Anaesth 1991; 66: 703–712.Google Scholar
Dahl V, Ræder JC, Droesdal S, Wathne O, Brynhildsrud J. Prophylactic oral ibuprofen or ibuprofen-codeine versus placebo for postoperative pain after primary hip arthroplasty. Acta Anaesthesiol Scand 1995; 39: 323–326.Google Scholar
March L, Irwig L, Schwarz J, Simpson J, Chock C, Brooks P. N of 1 trials comparing a non-steroidal anti-inflammatory drug with paracetamol in osteoarthritis. BMJ 1994; 309: 1041–1046.Google Scholar
Chandrasekharan NV, Dai H, Roos LT, et al. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure and expression. Proc Natl Acad Sci USA 2002; 99: 13926–13931.Google Scholar
Montgomery JE, Sutherland CJ, Kestin IG, Sneyd JR. Morphine consumption in patients receiving rectal paracetamol and diclofenac alone and in combination. Br J Anaesth 1996; 77: 445–447.Google Scholar
Seymor RA, Kelly PJ, Hawkesford JE. The efficacy of ketoprofen and paracetamol (acetaminophen) in postoperative pain after third molar surgery. Br J Clin Pharmacol 1996; 41: 581–585.Google Scholar
Rømsing J, Møiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth 2002; 88: 215–226.Google Scholar
Bach PH, Hardy TL. Relevance of animal models to analgesic-associated papillary necrosis in humans. Kidney Int 1985; 28: 613–615.Google Scholar
Blume H, Ali SL, Elze M, et al. Relative Bioverfürbarkeit vom Paracetamol in Suppositorien-Zubereitungrn im Vergleich zu Tabletten. Arzneim-Forssch/Drug Res 1994; 12: 1333–1338.Google Scholar
Moore A, Collins S, Carroll D, McQuay H. Paracetamol with and without codeine in acute pain: a quantitative systematic review. Pain 1997; 70: 193–201.Google Scholar
Korpela R, Olkkola K. Paracetamol-misused good old drug? Acta Anaesthesiol Scand 1999; 43: 245–247.Google Scholar
Korpela R, Korvenoja P, Meteroja OA. Morphine-sparing effect of acetaminophen in pediatric day-case surgery. Anesthesiology 1999; 91: 442–447.Google Scholar
Peterson RG, Rumack BH. Age as a variable in acetaminophen overdose. Arch Int Med 1981; 141: 390–393.Google Scholar
Varassi G, Marinangeli F, Agro F, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg 1999; 88: 611–616.Google Scholar
Rosenblum M, Weller R, Conrad PL, Falvey EA, Gross JB. Ibuprofen provides longer lasting analgesia than fentanyl after laparascopic surgery. Anesth Analg 1991; 73: 255–259.Google Scholar
Owen H, Glavin RJ, Shaw NA. Ibuprofen in the management of postoperative pain. Br J Anaesth 1986; 59: 1371–1375.Google Scholar
Power I, Chambers WA, Greer IA, Ramage D, Simon E. Platelet function after intramuscular diclofenac. Anaesthesia 1990; 45: 916–919.Google Scholar
Weale A, Warwick D, Durant N. Is there haemostatic interaction between low-molecular weight heparin and non-steroidal analgesics after total hip replacement? Lancet 1993; 342: 995.Google Scholar
Fredman B, Zohar E, Golan E, Tillinger M, Bernheim J, Jedeikin R. Diclofenac does not decrease renal blood flow or glomerular filtration in elderly patients undergoing orthopedic surgery. Anesth Analg 1999; 88: 149–154.Google Scholar