Effectiveness of Intravenous Ibuprofen On Emergence Agitation in Children Undergoing Tonsillectomy With Propofol Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Study

Background: Emergence agitation (EA) has a negative effect on recovery from general anesthesia in children. Objectives: This study aimed to evaluate the effectiveness of intravenous ibuprofen in reducing the incidence of EA in children.Methods: This randomized, double-blind, placebo-controlled study analyzed data from patients aged 3–9 years undergoing tonsillectomy with propofol general anesthesia. These patients were randomly assigned to receive either the ibuprofen or the placebo intraoperatively. The primary endpoint was between-group difference in the incidence of EA after surgery. EA was defined as Pediatric Anesthesia Emergence Delirium score ≥ 10. The secondary endpoint included the associated factors of EA.Results: Eighty-nine patients were included in the study. Ibuprofen decreased the incidence of EA (8.9% in the treatment group vs. 34.1% in the control group; odds ratio [OR], 0.261; 95% confidence interval [CI], 0.094–0.724; P = 0.004). After the logistic regression analysis, anxiety behavior pre-anesthesia and high pain score after surgery were the risk factors related to EA (OR, 8.07; 95% CI, 1.12–58.07, P = 0.038 and OR, 2.78; 95% CI, 1.60–4.82, P < 0.001, respectively). Ibuprofen administration was the protective factor related to EA (OR, 0.05; 95% CI, 0.01–0.67, P = 0.023).Conclusions: In our studied cohort, intraoperatively infusing ibuprofen and relieving preoperative anxiety and postoperative pain can significantly reduce the incidence and severity of EA after propofol general anesthesia.Trial registration: ChiCTR2100045128 (07/04/2021)

Preemptive analgesic effectiveness of single dose intravenous ibuprofen in infants undergoing cleft palate repair: a randomized controlled trial

Background Correction surgery for cleft palate is recommended between 9 and 18 months of age. Patients suffer from acute pain after palatoplasty. Clinicians are hesitant to use opioids for analgesia concerning the potential high risk of respiratory adverse events. Intravenous ibuprofen perhaps be a suitable adjuvant to pain relief. We try to assess whether preoperative administration of intravenous ibuprofen can decrease opioid requirements following cleft palate repair in infants. Methods This single center prospective randomized clinical trial was performed from February to April 2021 at Department of Anesthesiology in Shanghai Children’s Medical Center. Forty patients ASA I-II, aged 9–24 months with isolated cleft palate and undergoing palatoplasty were randomized in a 1:1 ratio to receive either a single dose of 10 mg/kg ibuprofen intravenously or normal saline at induction. Children and infants postoperative pain scale (CHIPPS) was used for pain assessment. Those patients CHIPPS pain score equal or higher than 4 received analgesic rescue with titrating intravenous fentanyl 0.5 μg/kg and repeated in 10 min if required. The primary outcome was the amount of postoperative fentanyl used for rescue analgesia in postanesthesia care unit (PACU). Results Patients (n = 20 in each group) in IV-Ibuprofen group required less postoperative fentanyl than those in placebo group (p<0.001). There was no significant difference between two groups in first rescue analgesia time (p = 0.079) and surgical blood loss (p = 0.194). No incidence of obvious adverse events had been found within the first 24 h after surgery in both groups. Conclusions Preemptive intravenous administration ibuprofen 10 mg/kg at induction had a significant opioid sparing effect in early postoperative period without obvious adverse effects in infants undergoing palatoplasty. Trial registration CHICTR, CTR2100043718, 27/02/2021 http://www.chictr.org.cn/showproj.aspx?proj=122187

Intravenous Ibuprofen 400 Versus 800 mg Every 6 Hours in Abdominal and Orthopedic Surgery: A Multicenter, Randomized Controlled Trial

Background: Multimodal postoperative analgesia with intravenous ibuprofen can reduce the consumption of opioids and reduce the postoperative pain intensity. Recommended dose in the USA and Europe is 800 mg every 6 hours for the management of moderate to severe postoperative pain. The purpose of this study was to investigate whether 800 mg is needed in the Chinese population.Methods: This is a multicenter, randomized, controlled multi-center trial. Adult patients (18-65 years of age) scheduled for abdominal or orthopedic surgery under general anesthesia with endotracheal intubation were eligible. Subjects were randomized at a ratio of 1:1:1 to receive ibuprofen at 400 or 800 mg or saline every 6 hours for 48 hours after the operation. All subjects received morphine access through patient-controlled intravenous analgesia (PCIA) device, which was set as background infusion rate 0.5 mg/h, bolus 1 mg, 5-minute lock interval and 20-mg 4-hour limit. The primary endpoint was morphine consumption within the first 24 hours after surgery. Results: A total of 396 patients were enrolled (180 men, 216 women; 46±12.4 years of age; 106 patients receiving abdominal surgery, and 290 patients receiving orthopedic surgery). The number of patients was 131 in the placebo group, 132 in the 400-mg group, and 133 in the 800-mg group. The 3 groups did not differ in age, sex, BMI and the type of surgery. Median 24-hour morphine consumption was 39.1 mg (IQR: 29.7, 61.7) mg in the placebo control, 29.8 mg (IQR: 24.3, 43.7) mg in the 400-mg group, and 28.0 mg (IQR: 24.1, 35.9) in the 800-mg group (P<0.001 for comparisons between placebo versus 400 and 800 mg ibuprofen). There was no significant difference between the two ibuprofen groups (P=0.125). Analgesia-related adverse events did not differ among the 3 groups.Conclusions: Intravenous ibuprofen at either 400 or 800 mg every 6 hours could reduce postoperative morphine consumption, with apparently equal efficacy in Chinese population.

The effects of pre-emptive intravenous ibuprofen on the thiol/disulfide homeostasis and C-reactive protein level as the markers of oxidative stress and inflammation during gynecologic laparoscopy: A randomized clinical trial

Aims: In this study, we aimed to investigate the anti-inflammatory and antioxidant effects of intravenous ibuprofen by using the C-reactive protein level and thiol/disulfide homeostasis as the oxidative stress marker. Materials and Methods: This study was conducted on 70 patients aged between 30and65 who were scheduled for elective laparoscopic hysterectomy. The patients were divided into two groups to receive either preemptive 800mg of intravenous ibuprofen plus 1000 mg of intravenous paracetamol (Group IP) or only 1000 mg of intravenous paracetamol as a control group (Group P).The blood samples for thiol/disulfide homeostasis were collected as follows; before induction of anesthesia (T0),before pneumoperitoneum (T1),following post-deflation and discontinuation of anesthesia (T2) and postoperative 24th hour (T3).Simultaneous blood samples for C-reactive protein were also collected. The pre and postoperative urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were measured. Results: A total of 69 patients were included in the study. The patient’s characteristics and intraoperative variables were comparable between groups (p>0.05). The number of patients requiring rescue analgesia, the total amount of analgesic used, VAS scores, and postoperative side effects were significantly lower in Group IP (p<0.001).There decrease in native and total thiol levels at T1, T2, T3 measurement points was significant in Group IP (p<0.001). In both groups, the comparison to baseline values demonstrated no significant changes in terms of disulfide level (p>0.05).The simultaneous CRP levels indicated a significant increase at the postoperative 24.hour in both groups (p<0.001). The difference between groups was insignificant (p>0.05). There was a significant increase in urea and creatinine levels in patients of Group IP (p<0.05). Conclusion: The pre-emptive administration of ibuprofen provided an effective pain control after gynecologic laparoscopy. However, ibuprofen changed the thiol/disulfide homeostasis in favor of oxidation and had no beneficial effect in surgically induced oxidative stress.