Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparison of Analgesic Effects of Paracetamol and Ibuprofen After Laparoscopic Cholecystectomy
Laparoskopik Kolesistektomi Sonrası Parasetamol ve İbuprofenin Postoperatif Analjezik Etkilerinin Karşılaştırılması
Öznur DEMİROLUKa, Süheyla ABİTAĞAOĞLUa, Dilara KARACA GÖÇMENa, Yetkin ÖZCABIb, Dilek ERDOĞAN ARIa
Departments of
aAnesthesiology and Reanimation,
bGeneral Surgery, University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(3):278-84
doi: 10.5336/medsci.2018-63679
Article Language: EN
Full Text
ABSTRACT
 Objective: Non-steroid anti-inflammatory drugs (NSAIDs) and paracetamol (P) are frequent constituents of multimodal postoperative analgesia. The aim of this study was to compare analgesic effects of intravenous (IV) paracetamol and ibuprofen (IB) administered intraoperatively and in repeated doses postoperatively to the patients who underwent laparoscopic cholecystectomy. Material and Methods: A total of 40 patients with class of American Society of Anesthesiologists (ASA) I-III who underwent laparoscopic cholecystectomy were randomized into Groups-P and IB in this randomized, prospective and double-blind study. After anesthesia induction and initiation of the surgery, Group-P patients received 1 g IV paracetamol and Group-IB patients received 800 mg IV ibuprofen. At skin closure, 1.5 mg/kg of IV tramadol was administered. For postoperative analgesia, a patient-controlled analgesia (PCA) pump with tramadol was used. During the first 24h postoperatively, Group-P patients received 1 g of IV paracetamol and Group-IB patients received 400 mg of IV ibuprofen at every 6h. Patients with visual analog pain scale (VAS) scores ≥ 4 received rescue analgesia. The groups were compared for postoperative first 24h VAS scores, PCA demand, total tramadol dose, and rescue analgesic requirement. Results: Compared with Group-P, Group-IB had significantly lower VAS-awakening, VAS-post-anesthesia care unit (PACU) and VAS- 6th h scores. Postoperative rescue analgesic requirement was lower in Group-IB than in Group-P at all timepoints, most notably in the PACU. Conclusion: Compared with paracetamol, intraoperative and repeated postoperative doses of ibuprofen substantially decreased the pain scores and rescue analgesic requirement. As a component of multimodal analgesia, IV ibuprofen is an effective option for postoperative pain management.

Keywords: Ibuprofen; postoperative pain; analgesia; laparoscopic cholecystectomy; paracetamol
ÖZET
 Amaç: Non-steroid anti-inflamatuar ilaçlar (NSAİİ) ve parasetamol multimodal postoperatif ağrı tedavisinde sıklıkla kullanılan ilaçlardır. Bu çalışmanın amacı, laparoskopik kolesistektomi operasyonu geçiren hastalarda intraoperatif ve postoperatif dönemde tekrarlanan dozlarda uygulanan intravenöz (IV) parasetamol ve ibuprofen'in analjezik etkilerinin karşılaştırılmasıdır. Gereç ve Yöntemler: Randomize, prospektif, çift-kör olan bu çalışmada laparoskopik kolesistektomi geçiren ASAI-III toplam 40 hasta Grup-P ve Grup-IB olarak randomize edildi. Anestezi indüksiyonu sonrası cerrahi başlangıcında Grup-P'deki hastalara 1 g parasetamol ve Grup-IB'deki hastalara 800 mg ibuprofen IV olarak uygulandı. Cilt sutürlerine geçildiğinde 1,5 mg/kg IV tramadol verildi. Postoperatif analjezide tramadol ile hazırlanmış hasta kontrollü analjezi cihazı (HKA) kullanıldı. Postoperatif ilk 24 saat boyunca Grup-P'deki hastalara 1gr parasetamol, Grup-IB'deki hastalara 400mg ibuprofen 6 saat arayla IV olarak uygulandı. VAS skorları ≥ 4 olan hastalara kurtarıcı analjezik uygulandı. Gruplar postoperatif ilk 24 saat VAS skorları, HKA kullanım miktarı, toplam tramadol miktarı, kurtarıcı analjezik gereksinimi açısından karşılaştırıldı. Bulgular: Grup-P ile karşılaştırıldığında Grup-IB'de VAS- uyanma, VAS-anestezi sonrası bakım ünitesi ve VAS-6.saat değerleri belirgin olarak düşüktü. Postoperatif kurtarıcı analjezik gereksinimi özellikle anestezi sonrası bakım ünitesinde olmak üzere tüm dönemlerde anlamlı olarak düşüktü. Sonuç: Parasetamol ile karşılaştırıldığında intraoperatif ve postoperatif tekrarlayan dozlarda IV ibuprofen uygulaması, postoperatif dönemde ağrı skorlarını ve kurtarıcı analjezik gereksinimini belirgin olarak düşürmektedir. Multimodal analjezinin bir parçası olarak IV ibuprofen postoperatif ağrı tedavisinde etkili bir analjezik seçeneğidir.

Anahtar Kelimeler: İbuprofen; postoperatif ağrı; analjezi; laparoskopik kolesistektomi; parasetamol
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