Comparing Ketorolac With Ibuprofen for Postoperative Pain: A Randomized Clinical Trial

Abstract

Objectives The objective of this study was to identify differences in pain perception and satisfaction with pain control in women receiving nonsteroidal anti-inflammatory drugs postoperatively. Methods This was a prospective, randomized controlled trial including urogynecology surgical patients. After surgery, all patients were randomized to receive either intravenous (IV) ketorolac or ibuprofen. The patients completed 3 visual analog scales (VAS) assessing pain at rest, pain with ambulation, and satisfaction with pain control. Postoperative opioid use was also measured. Results A total of 224 patients (112 in each arm) were included. Pain scores (SD) at rest in all patients who received ketorolac versus those who received ibuprofen was 2.30 (2.1) versus 2.68 (2.34) (P = 0.20). Pain scores (SD) with ambulation was 3.94 (2.57) versus 4.16 (2.73) (P = 0.57) in patients who received ketorolac and ibuprofen, respectively. Patients who received ketorolac rated their satisfaction with their pain regimen similarly to those who received ibuprofen (P = 0.50). The average amount (SD) of hydromorphone used in the ketorolac and ibuprofen arm was 3.68 (4.58) mg and 4.04 (4.97) mg, respectively (P = 0.58). A subgroup analysis based on type of surgery showed decreased pain at rest (VAS, 2.77 vs 4.88; P = 0.04) and increased satisfaction (VAS, 1.69 vs 4.67; P = 0.003) in patients who had laparotomy and received ketorolac. Conclusions There was no difference in pain and satisfaction with IV ketorolac compared with IV ibuprofen in patients who underwent all modalities of urogynecologic surgery. A subgroup of patients who underwent laparotomy had less pain with ketorolac.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

“…Ketorolac is often used in patients who cannot tolerate oral medications. In a randomized trial to assess the benefit of ketorolac (vs. placebo) after outpatient urogynecological surgery, a single IV dose did not reduce pain or opioid use 69 . In a larger study comparing IV ibuprofen to IV ketorolac in FPMRS patients, there was no difference in pain, satisfaction, or opioid use postoperatively 70 …”

“…In a randomized trial to assess the benefit of ketorolac (vs. placebo) after outpatient urogynecological surgery, a single IV dose did not reduce pain or opioid use. 69 In a larger study comparing IV ibuprofen to IV ketorolac in FPMRS patients, there was no difference in pain, satisfaction, or opioid use postoperatively. 70 (2) Gabapentinoids While gabapentinoids (gabapentin and pregabalin) have been part of ERAS protocols, recent evidence questions their effectiveness in reducing postoperative opioid requirements.…”

Intravenous ibuprofen for acute treatment of migraine: A double‐blind, randomized, placebo‐controlled pilot study

“…Earlier studies with oral ibuprofen (200–600 mg) demonstrated improved migraine pain relief versus placebo at 2 h 20–23 . IV ibuprofen (800 mg in 250 ml saline) has been studied for adjunctive postoperative pain management 24,25 ; in these trials, the efficacy of IV ibuprofen appears comparable with that of IV ketorolac on pain reduction (visual analog scale; VAS) 17,26 . For use in migraine, IV ibuprofen (800 mg in 500 ml saline) appeared less effective than IV dexketoprofen and IV metoclopramide (measured by a change in VAS at 30 min) in a small non‐placebo‐controlled prospective study 27 .…”

“…15 IV ibuprofen is as effective as IV ketorolac for treating perioperative pain. [16][17][18] IV ibuprofen may thus offer another parenteral NSAID option for acute headache treatment, but its efficacy in migraine is not well known. We hypothesized that IV ibuprofen reduces migraine pain intensity at 2 h after infusion.…”

“…Due to its balanced cyclooxygenase inhibition profile, ibuprofen has less bleeding risk than more cyclooxygenase‐selective NSAIDs 15 . IV ibuprofen is as effective as IV ketorolac for treating perioperative pain 16–18 . IV ibuprofen may thus offer another parenteral NSAID option for acute headache treatment, but its efficacy in migraine is not well known.…”