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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.24089    [Epub ahead of print]
Published online May 7, 2024.
Effect of perioperative intravenous ibuprofen versus acetaminophen on postoperative opioid consumption and pain after general anesthesia: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials
Sung Hye Kim1  , Hyun Kang2  , In-Jung Jun1  , Hye Won Park3  , Byung Hoon Yoo1  , Yun-Hee Lim1  , Kye-Min Kim1 
1Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
2Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
3Inje University Medical Library, Busan, Korea
Corresponding author:  Kye-Min Kim, Tel: +82-2-950-1168, Fax: +82-2-950-1323, 
Email: kyemin@paik.ac.kr
Received: 6 February 2024   • Revised: 2 April 2024   • Accepted: 9 April 2024
Ibuprofen and acetaminophen are widely used as adjuvant analgesics for postoperative pain. This meta-analysis compared the effects of intravenous (IV) ibuprofen and acetaminophen on postoperative opioid consumption and pain intensity after general anesthesia.
PubMed/MEDLINE, EMBASE, and Cochrane Library databases were searched to identify relevant studies published up to May 2023. Randomized controlled trials (RCTs) comparing the effects of perioperative IV ibuprofen and acetaminophen on postoperative opioid consumption and pain after general anesthesia were included in the meta-analysis and trial sequential analysis (TSA).
Eight studies with 494 participants were included. Compared to IV acetaminophen, IV ibuprofen significantly reduced 24 h opioid consumption, presented as morphine equivalents (mean difference [MD]: –6.01 mg, 95% CI [–8.60, –3.42], P < 0.00001, I2 = 55%), and pain scores (on a scale of 0–10) at 4–6 h (MD: –0.83, 95% CI [–1.29, –0.37], P = 0.0004, I2 = 65%) and 12 h (MD: –0.38, 95% CI [–0.68, –0.08], P = 0.01, I2 = 11%) postoperatively. These results were statistically significant in TSA. Pain scores at 24 h postoperatively and side effects were not significantly different between the two groups in the meta-analysis, and TSA revealed that the sample size was too small to adequately evaluate the effects, requiring further studies for conclusive results.
Perioperative IV ibuprofen reduced 24 h opioid consumption and pain severity up to 12 h postoperatively compared to acetaminophen. Additional research is required to assess pain intensity beyond 12 h and side effects.
Key Words: Acetaminophen; General anesthesia; Ibuprofen; Meta-analysis; Opioid analgesics; Postoperative pain


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