Findings from a new trial in JAMA suggest ibuprofen alone could significantly reduce postoperative morphine usage, without increasing serious adverse events (SAEs).
The randomised controlled trial included 559 patients across six Danish hospitals who underwent total hip arthroplasty (THA) from December 2015 to October 2017. Participants were randomised to receive 1,000mg paracetamol plus 400mg ibuprofen (n=136), 1,000mg paracetamol plus matched placebo (n=142), 400mg ibuprofen plus matched placebo (n=141), or 500mg paracetamol plus 200mg ibuprofen orally (n=140) every six hours for 24 hours postoperatively, starting one hour before surgery.
Median 24-hour morphine consumption was 20mg in the paracetamol plus ibuprofen group, 36mg for paracetamol alone, 26mg for ibuprofen alone, and 28mg for half-strength paracetamol plus ibuprofen group. While the difference between the paracetamol plus ibuprofen group and the paracetamol alone group were significant, all other comparisons were not clinically important.
There was no statistically significant increase in SAEs in the pooled groups receiving ibuprofen alone versus paracetamol alone.
“Although the combined use of paracetamol and ibuprofen reduced immediate postoperative morphine consumption compared with paracetamol alone in patients undergoing THA, ibuprofen alone resulted in comparable pain control without increasing SAEs, suggesting that ibuprofen alone may be a reasonable option,” the authors concluded.