Safety of additional intravenous acetaminophen/ibuprofen administration in patients undergoing robot-assisted renal surgery with postoperative ketorolac-based patient-controlled analgesia: A retrospective propensity-score-matched analysis.

PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management following robot-assisted renal surgery. However, concurrent dual NSAID administration raises concerns regarding an increased risk of acute kidney injury (AKI). This study evaluated the renal safety of adding an intravenous combination of acetaminophen and ibuprofen to ketorolac-based patient-controlled analgesia (PCA) in patients undergoing robot-assisted renal surgery.

MATERIALS AND

METHODS

This retrospective cohort study analyzed 200 adult patients who underwent robot-assisted renal surgery between September 2023 and September 2025. Patients receiving a combination of ketorolac PCA plus acetaminophen/ibuprofen (n=90, treatment group) were compared with those receiving ketorolac PCA alone (n=110, control group). After 1:1 propensity score matching, 72 patients per group were analyzed. The primary outcome was postoperative AKI diagnosed by serum creatinine changes through postoperative day 7 or until discharge, whichever occurred first.

RESULTS

In the matched cohort, postoperative AKI occurred in 28 patients (38.9%) in the treatment group and 32 patients (44.4%) in the control group, with no significant difference (p=0.499; risk ratio 0.89, 95% confidence interval [CI] 0.64-1.24). Serial serum creatinine trajectories were similar between groups. Multivariable logistic regression identified pneumoperitoneum duration as an independent risk factor for AKI (odds ratio 1.02, 95% CI 1.01-1.04, p=0.012), while an acetaminophen/ibuprofen combination was not associated with increased AKI risk (odds ratio 0.80, 95% CI 0.41-1.54, p=0.499).

CONCLUSIONS

Adding intravenous acetaminophen/ibuprofen combination to ketorolac PCA was not significantly associated with postoperative AKI risk in patients who underwent robot-assisted renal surgery.