Intravenous ibuprofen in postoperative pain and fever management in adults: A systematic review and meta‐analysis of randomized controlled trials

Abstract

This study aims to evaluate the efficacy and safety of multiple or single‐dosage intravenous ibuprofen (IVIB) in managing postoperative pain and fever in adults who are unable to take oral medications. A systematic review and meta‐analysis was conducted based on randomized controlled trials (RCTs) comparing IVIB with placebo or other analgesic and antipyretic medications for postoperative pain and fever management. Data were collected from 8 main databases from the inception to June 2022. Risk of bias assessment was performed, and the GRADE methodology was used to assess the certainty of pooled evidence. Primary outcomes included visual analogue scale (VAS) scores within 24 h postoperative and reduction of temperature. Meta‐analyses were conducted to calculate the mean difference (MD) or risk ratios (RR) and 95% CIs. As a result, a total of twenty‐three RCTs with 3716 participants were included. For postoperative pain, with moderate‐to‐low certainty evidence, IVIB was associated with lower postoperative VAS scores than placebo, with MD ranging from −3.53 (95% CI, −4.32 to −2.75) at 0 min to −0.96 (95% CI, −1.35 to −0.57) at 24 h. Compared with intravenous acetaminophen, IVIB demonstrated lower VAS scores (MD, −1.54 at 0 min; −0.36 at 24 h). For fever, IVIB showed satisfactory antipyretic efficiency in a short period of time, but no difference was observed between IVIB and intravenous acetaminophen. IVIB was well‐tolerated for both pain and fever management. In conclusion, moderate‐to‐low certainty evidence supports the use of IVIB for adults with postoperative pain and fever who are unable to take oral medications.

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

“…The results of this study regarding the effect on opioid consumption and pain scores are in line with those of a recent meta-analysis by Zhou et al [ 26 ], who evaluated the analgesic and antipyretic effects of IV ibuprofen compared with those of placebo and acetaminophen. However, the studies included by Zhou et al [ 26 ] were more heterogeneous than ours; the anesthetic types varied from local anesthesia to regional and general anesthesia, and endoscopic procedures were also included. Furthermore, the effect on opioid consumption has not been adequately assessed, as the opioid-sparing effects of ibuprofen and acetaminophen were evaluated for each type of opioid (tramadol, fentanyl, and morphine).…”