Archive May 2015 XVI, No. 5

Anesthesia Alert: IV Ibuprofen Before Surgery Speeds Recovery

Study: It pays to modulate the body's stress response to surgery.

Vanny Le, MD

BIO

medication TIMING IS EVERYTHING The best time to give patients IV ibuprofen is before surgery, not after.

A dministering IV ibuprofen (Caldolor) before surgery can pay for itself many times over — hastening recovery, increasing patient satisfaction, and reducing pain and the need for opioids. Pre-op administration of the NSAID may even improve the way patients bounce back cognitively.

Preempting post-op pain
Those were among our findings in a recent study at the Rutgers University New Jersey School of Medicine. Using a diverse population of 55 patients undergoing laparoscopic cholecystectomies at 3 tertiary academic hospitals, we demonstrated the benefit of administering anti-inflammatories before surgery instead of waiting until after, when the body's stress response to surgery has already kicked in. We suspect other anti-inflammatories and analgesics may have the same positive effect. In fact, our team plans to look at ketorolac and acetaminophen in the days ahead.

In the randomized, double-blind ibuprofen study, "Preoperative Administration of IV Ibuprofen Improves Quality of Recovery After Laparoscopic Cholecystectomy" (osmag.net/SQW6pu), we gave 28 patients 800 mg of ibuprofen and 27 patients a placebo-saline before they were induced with general anesthesia. To compare responses, we used the 40-item Quality of Recovery questionnaire, a 9-item Modified Fatigue Severity Scale and a 15-item Geriatric Depression Scale, each of which we assessed 4 times — before surgery, in the PACU, 1 day after surgery and 3 days after surgery.

Among other findings, the patients given ibuprofen fared significantly better in just about every way and at every step along the way. They had less pain, they were more upbeat, they slept better and they were able to get back to normal activities faster. Additionally, while the placebo group showed a spike in fatigue immediately after surgery, the ibuprofen group had no change in fatigue. The only area in which the ibuprofen group didn't show a benefit involved the ability to communicate with staff and to follow instructions. Here, there was no difference between the groups.

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