17: Comparing methods of nsaid delivery for postoperative pain


      To compare differences in pain perception and satisfaction with pain control in women receiving either intravenous ibuprofen or intravenous ketorolac after urogynecologic surgery.

      Materials and Methods

      This was a prospective randomized controlled trial including patients undergoing surgery in the division of Female Pelvic Medicine and Reconstructive Surgery between September 2013 and April 2015. After surgery, all patients were randomized to either the ibuprofen or ketorolac groups. Patients were placed on a patient controlled analgesia (PCA) of hydromorphone with standardized settings and given scheduled, oral acetaminophen. On the first postoperative day before noon, three visual analog scores were obtained from the patient to assess pain at rest, ambulation, and satisfaction with pain control. Demographic data and surgical data were collected including the type of surgery (vaginal, laparoscopic, or open) as well as concomitant procedures. The amount of hydromorphone used and the length of time with the PCA were recorded. Statistical analysis was performed using SAS v9.3. Continuous variables were summarized using means and standard deviations; categorical variables were summarized using counts and proportions. Continuous and categorical variables were compared between the two arms using two-sample t-test and chi-squared test, respectively, with a p<0.05 defined as significant.


      A total of 332 patients were approached for the study, of which twenty-four patients declined to participate, and 54 patients withdrew. The remaining 228 patients were enrolled and randomized in the study. Four patients were removed from analysis due to missing medication, resulting in a total of 224 patients (112 patients in each arm) to be included in the statistical analysis. The majority of patients were White (92%) with a mean age of 57 years old (±13 years). Only 16% of participants were taking narcotics prior to surgery. There were statistically significant differences in the two arms of the study, with more patients in the ketorolac arm who underwent a sacrocolpopexy (59% vs 46%, p = 0.05), and more patients in the ibuprofen arm received local anesthetic into the incision (84% vs 73%, p= 0.05). Overall, there was no difference in pain scores at rest or ambulation between the two study groups (Table 1). Additionally, there was no difference in patient satisfaction between the two pain regimens. There was no difference in the amount of hydromorphone used in each of the two study arms (p = 0.58).


      In this randomized trial, there were no significant differences when comparing intravenous ketorolac to ibuprofen as an adjunct for postoperative pain control after urogynecologic surgeries. Both regimens had a high level of postoperative satisfaction.
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