Comparison of the Prophylactic Effect of Intravenous Ibuprofen and Intramuscular Piroxicam on Pain Severity after Lower Abdominal Surgery

Document Type : Original Article(s)

Authors

1 Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: One of the most common complications of surgery is postoperative pain that Lack of control of this pain causes complications such as ileus, pulmonary atelectasis and increased hospital stay. The goal of this clinical trial was comparison of the effect of ibuprofen and piroxicam on pain relief after lower abdominal surgery and the amount of opioid used after surgery.
Methods: In a clinical trial, 90 patients undergoing lower abdominal surgery were distributed among three groups of 30 people. First group received 1cc intramuscular piroxicam and 4cc intravenous normal saline, second group received 4cc intravenous ibuprofen and 1cc intramuscular normal saline and third group received 1cc intramuscular and 4cc intravenous normal saline. Pain intensity after full consciousness and at 2, 8, 12 and 24 hours after surgery, the amount of opioid used in the first 24 hours and patients' satisfaction with pain relief after 24 hours were recorded.
Findings: The mean of pain intensity at 2 (P = 0.016), 8 (P < 0.001) and 12 hours (P = 0.018) after surgery in the three groups was significantly different but the pain intensity, after consciousness (P = 0.605) and at 24 hours (P = 0.331) was not significantly different between three groups. The amount of consumed opioid was significantly different between three groups (P < 0.001).
Conclusion: Ibuprofen and piroxicam are effective in reducing postoperative pain and opioid consumption after lower abdominal surgery but their effects are not different.

Keywords


  1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97(2): 534-40.
  2. Sultana A. Miller's anesthesia review [Book Review]. Anaesth Intensive Care 2019; 47(3): 311.
  3. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003; 362(9399): 1921-8.
  4. Gandhi K, Heitz JW, Viscusi ER. Challenges in acute pain management. Anesthesiol Clin 2011; 29(2):
    291-309.
  5. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85(1): 109-17.
  6. 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.
  7. Gupta A, Bah M. NSAIDs in the Treatment of Postoperative Pain. Curr Pain Headache Rep 2016; 20(11): 62.
  8. Wirz S. Management of adverse effects of opioid therapy [in German]. Z Gastroenterol 2017; 55(4):
    394-400.
  9. Edwards JE, Loke YK, Moore RA, McQuay HJ. Single dose piroxicam for acute postoperative pain. Cochrane Database Syst Rev 2000; 2000(4): Cd002762.
  10. Kim SY, Lee S, Lee Y, Kim H, Kim KM. Effect of single dose preoperative intravenous ibuprofen on postoperative pain and opioid consumption: a systematic review and meta-analysis. Korean J Anesthesiol 2021; 74(5): 409-21.
  11. Uribe AA, Arbona FL, Flanigan DC, Kaeding CC, Palettas M, Bergese SD. Comparing the efficacy of IV ibuprofen and ketorolac in the management of postoperative pain following arthroscopic knee surgery. A randomized double-blind active comparator pilot study. Front Surg 2018; 5: 59.
  12. Voutilainen A, Pitkäaho T, Kvist T, Vehviläinen-Julkunen K. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Adv Nurs 2016; 72(4): 946-57.
  13. Chinnaiyan S, Sarala N, Arun HS. A comparative study of efficacy and safety of flupirtine versus piroxicam in postoperative pain in patients undergoing lower limb surgery. J Pain Res 2017; 10: 2471-7.
  14. Gozeler MS, Sakat MS, Kilic K, Ozmen O, Can A, Ince I. Does a single-dose preemptive intravenous ibuprofen have an effect on postoperative pain relief after septorhinoplasty? Am J Otolaryngol 2018; 39(6): 726-30;
  15. Akbas S, Ozkan AS, Durak MA, Yologlu S. Efficacy of intravenous paracetamol and ibuprofen on postoperative pain and morphine consumption in lumbar disc surgery: Prospective, randomized, double-blind, placebo-controlled clinical trial. Neurochirurgie 2021; 67(6): 533-9.
  16. Ciftci B, Ekinci M, Celik EC, Kaciroglu A, Karakaya MA, Demiraran Y, et al. Comparison of intravenous ibuprofen and paracetamol for postoperative pain management after laparoscopic sleeve gastrectomy. a randomized controlled study. Obesity Surgery 2019;
    29(3): 765-70.
  17. Farshchi A, Ghiasi G. Comparison the analgesic effects of single dose administration of tramadol or piroxicam on postoperative pain after cesarean delivery. Acta Med Iran 2010; 48(3): 148-53.
  18. Dwarica DS, Pickett SD, Zhao YD, Nihira MA, Quiroz LH. Comparing ketorolac with ibuprofen for postoperative pain: A randomized clinical trial. Female Pelvic Med Reconstr Surg 2020; 26(4):
    233-8.
  19. Selçuk E, Gomel M, Apaydin S, Köse T, Tuglular I. The postoperative analgesic efficacy and safety of piroxicam (FDDF) and naproxen sodium. Int J Clin Pharmacol Res 1998; 18(1): 21-9.
  20. Kohli SS, Kohli VS. Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences: A randomized control trial. Angle Orthod 2011; 81(6): 1097-102.