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Postoperative Benefits Seen With Preoperative IV Ibuprofen

To the well-documented analgesic benefits of IV ibuprofen add this: Preoperative administration of the nonsteroidal anti-inflammatory drug (NSAID) improves the overall quality of recovery. A recent study also revealed that IV ibuprofen also might improve postoperative cognitive recovery.

According to Vanny Le, MD, and a team of researchers from Rutgers New Jersey Medical School in Newark, the stress response to surgery may lead to a number of postoperative complications, including diminished quality of recovery. Because NSAIDs may decrease activation of the stress response, the researchers hypothesized that IV ibuprofen might improve recovery characteristics in patients undergoing laparoscopic cholecystectomy.

“Our study specifically looks at the optimization of anesthetic management in order to enhance recovery and minimize some postoperative sequelae that occur after surgery,” said Dr. Le, an assistant professor of anesthesiology. “So we looked at IV ibuprofen, which we believed would improve postoperative recovery.”

To that end, Dr. Le and her colleagues enrolled 55 individuals undergoing laparoscopic cholecystectomy into the prospective, randomized double-blind study. Each patient received a single preoperative IV dose of either ibuprofen 800 mg (n=28) or placebo saline (n=27). A number of parameters were measured—including quality of recovery, fatigue, mood and cognitive capacity—at four time points: preoperatively, in the postanesthesia care unit (PACU) and on postoperative days (POD) 1 and 3.

As Dr. Le reported at the 2014 annual meeting of the American Society of Anesthesiologists (abstract A2019), global quality of recovery scores (as measured using the 40-item Quality of Recovery [QoR40] questionnaire) were higher for patients taking ibuprofen than for controls (P<0.001) on POD 1 (Figure 1). Patients in the ibuprofen group also proved superior in the QoR40 domains of comfort, emotion and pain.

“QoR40 scores were the same for both groups preoperatively,” Dr. Le said. “But on postoperative day 1, there was a significant decline in the placebo group, whereas there was no change in the ibuprofen group. By postoperative day 3, these scores had returned to baseline for the placebo group.”

Similarly, analysis of the nine-item Modified Fatigue Severity Scale revealed that patients in the ibuprofen group had significantly lower scores at every postsurgical evaluation point than their counterparts in the placebo group (Figure 2). Perhaps not surprisingly, there was a significant time effect in the placebo group, with significantly higher fatigue scores recorded in the PACU and on POD 1 than before surgery.

Global analyses using the Digits Span Forward and Backward (DSF/DSB) tests revealed the significant effects of time and ibuprofen. Indeed, patients taking ibuprofen had highe r DSB scores in the PACU than did patients who were given placebo (P<0.05).

“There was no significant decline in physical independence in the placebo group on postoperative day 1, but patient support was the same for all time periods after the surgery,” Dr. Le said. “I also think the difference here is that patient support is determined independent of surgical factors and is more dependent on the patient’s social situation.”

Andrea Kurz, MD, called the study interesting, important and promising. “In general, I believe that any drug that effects perioperative inflammation might be beneficial … as long as we believe that most ‘bad’ postoperative outcomes are related to inflammation, which I do,” said the professor and vice-chair of anesthesiology at the Cleveland Clinic, in Ohio.

“My biggest concern with respect to the study is sample size,” Dr. Kurz continued. “In other words, the results are almost too good to be true. Also, their interaction results are interesting, but again, we usually need many more patients for such analyses.”

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