POST OPERATIVE OPIOD SPARING EFFECT OF INTRAVENOUS IBUPROFEN IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOM

Abstract

Background: Even though the procedure of laparoscopic cholecystectomy is minimally invasive, postoperative pain is prevalent. Early postoperative pain is caused by CO2 pneumoperitoneum, diaphragmatic irritation, stretching of the abdominal wall and port-site trauma. Opioids are effective analgesics, but can cause nausea, vomiting, sedation, respiratory depression and other side effects. In combination with multimodal analgesia, intravenous ibuprofen may be an opioid-sparing option. Objective: To compare the opioid-sparing effect of intraoperatively administered intravenous ibuprofen and placebo in terms of Mean postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy. Methods: This was a Randomized Controlled Trial that was carried out at Department of Anesthesia, National Hospital & Medical Center Lahore from April 2025 to August 2025. 60 ASA I-II patients aged 18-65 years who were undergoing elective Laparoscopic Cholecystectomy. The participants were divided into two groups, each with an equal number of individuals. The ibuprofen group was given 400 mg intravenous ibuprofen and the control group was given 100 mL normal saline 20 minutes prior to extubation. Visual analog scale (VAS) was used to assess postoperative pain at 12 hours intervals for 12 hours. If the VAS score was >5, then intravenous tramadol 1 mg/kg was administered. Primary outcome was total consumption of tramadol in the first 12 hours after surgery. Results: Mean 12-hour tramadol consumption was significantly lower with ibuprofen than placebo (148.6 ± 62.4 vs 312.8 ± 98.7 mg; mean difference 164.2 mg; 95% CI 122.4–206.0; p < 0.001), representing a 53% reduction. Rescue analgesia was required in 7 (23.3%) versus 22 (73.3%) patients, respectively (p < 0.001). Time to first rescue analgesia was longer with ibuprofen (7.8 ± 2.1 vs 3.4 ± 1.6 hours; p < 0.001). The ibuprofen group had significantly lower VAS scores at all follow-up periods. Conclusion: Intravenous ibuprofen given during surgery can significantly decrease the amount of tramadol needed in the early postoperative period, and provide superior pain control following laproscopic cholecystectomy, compared to the control group. It has been shown to have an opioid-sparing effect which makes it an appropriate addition to multimodal perioperative analgesia.