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The analgesic effects of the addition of intravenous ibuprofen to multimodal analgesia regimen for pain management after pediatric cardiac surgery: a randomized controlled study

Published:November 21, 2022DOI:https://doi.org/10.1053/j.jvca.2022.11.016

      Highlights

      • NSAIDs provide good perioperative analgesia in cardiac surgery, but can cause gastritis, bleeding or renal dysfunction.
      • Intravenous ibuprofen is associated with less side effects than the other NSAIDs.
      • Intravenous ibuprofen provides effective postoperative analgesia in children undergoing open cardiac surgery.
      • To comment on the safety of ibuprofen, multicenter studies with a large number of patients are required.

      ABSTRACT

      Study objective

      : Intravenous ibuprofen is used to control fever and pain. This study aimed to assess the analgesic effects of the addition of intravenous ibuprofen to multimodal analgesia regimen for pain management after pediatric cardiac surgery.

      Design

      : A randomized, controlled, double-blinded, superiority study.

      Setting

      : University Hospital.

      Patients

      : 78 pediatric patients who underwent open cardiac surgery using midline sternotomy incision were screened for eligibility, of whom 10 were excluded leaving 68 patients (34 patients in the ibuprofen group and 34 patients in the control group) for final data analysis.

      Interventions

      : Patients were randomly allocated to either ibuprofen group in which the patient received intravenous ibuprofen infusion, 10mg/kg/6 h for 24 h or the control group in which the patient received a placebo 0.9% saline.

      Measurements and main results

      : The primary endpoint was the 24 h postoperative fentanyl consumption and the secondary endpoints were postoperative modified objective pain score (MOPS) and the incidence ibuprofen-related side effects including vomiting, epigastric pain, bleeding and renal dysfunction. The mean (SD) total fentanyl consumption (μg/kg) during the first postoperative 24 h following extubation was significantly lower (<0.001) in the ibuprofen group (3.5±1.3) than the control group (5.1±1.4). The median (IQR) postoperative modified objective pain score (MOPS) was significantly lower (p<0.05) in the ibuprofen group than the control group at 0 h, 2 h, 12 h, 16 h, 20 h and 24 h postoperatively. Ibuprofen did not cause a significant increase in the incidence of bleeding, epigastric pain and vomiting. Postoperative renal dysfunction was not reported in any patient.

      Conclusions

      : The addition of intravenous ibuprofen to multimodal analgesia regimen for pain management after pediatric cardiac surgery improves the postoperative analgesia in terms of reduction of opioid consumption and pain scores.

      Key words

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