The effect of single dose preemptive intravenous ibuprofen and paracetamol on postoperative pain scores and opioid consumption in total abdominal hysterectomy surgery

Background: Hysterectomy surgery is the most common surgical procedure after cesarean section in gynecology practice. Perioperative pain control reduces mortality and morbidity, improves pain scores, and increases patient satisfaction. In this study, it was aimed to compare the analgesic effects of preemptive intravenous (IV) paracetamol and ibuprofen in the treatment of postoperative pain in patients undergoing total abdominal hysterectomy. Materials and Methods: 120 female patients aged between 30 and 65 years, who were considered ASA I or ASA II with the indication of total abdominal hysterectomy, who were scheduled for elective surgery were included in the study. The patients in the randomized, double-blind and placebo-controlled study were divided into 4 groups; Paracetamol given group (Group P: n=30), ibuprofen 400 mg group (Group I400: n=30), ibuprofen 800 mg group (Group I800: n=30), and isotonic control group (Group K: n=30) 30) was named. The patients were followed up for 24 hours postoperatively and fentanyl was administered with PCA. Demographic data of the patients, liver and kidney function tests, hemogram and coagulation parameters and anesthetic gas consumption were recorded. Hemodynamic data, pain scores and sedation scales, total opioid consumption and adverse events related to opioids were recorded for the patients in the postoperative recovery unit and service at 1, 2, 4, 6, 12 and 24 hours. QoR 40 score and patient satisfaction were evaluated at the postoperative 24th hour. Intraoperative additional fentanyl requirement and postoperative first analgesia request time were recorded. Results: The groups were similar to each other in terms of demographic data, duration of surgery, consumption of sevoflurane, and peroperative hemodynamic data. Pain scores in the I800 group were significantly lower than in the other groups (p˂0.001). The postoperative first analgesia period was significantly longer in the ibuprofen-administered groups compared to the other groups, and the need for additional intraoperative fentanyl dose was significantly lower (p1˂0.001), (p2˂0.001). Total opioid consumption was significantly higher in the control group compared to the vii other groups (p˂0.001). Patient satisfaction was lower in the Control group than in all other groups (p˂0.001). The highest patient satisfaction was recorded in the i800 group. There was no positive correlation between fentanyl dose and side effects related to opioids.. Conclusion: In the framework of the multimodal approach in postoperative pain management, it was observed that IV ibuprofen and IV paracetamol administered preemptively in addition to opioids reduced total fentanyl consumption, but only 800 mg ibuprofen reduced pain scores. No significant difference was detected between the two agents in terms of side effects. It was thought that preemptive administration of 800 mg ibuprofen could be used effectively in analgesia management in hysterectomy surgery. Keywords: Preemptive analgesia, postoperative analgesia, hysterectomy, patient-controlled analgesia, intravenous ibuprofen, paracetamol.