Comparison of the Effectiveness of Paracetamol and Ibuprofen Combination With Paracetamol and Ketorolac for Postoperative Analgesia in Cesarean Section: A Single Blind Randomized Clinical Trial.

BACKGROUND

Postoperative pain after cesarean section (CS) can significantly impact patient recovery and morbidity if not managed effectively. This study compares the efficacy of two multimodal analgesic combinations-paracetamol with ibuprofen (PI) and paracetamol with ketorolac (PK)-in managing postoperative pain after CS, and assesses the incidence of side effects.

METHODS

This single-blind clinical trial was conducted from June to July 2024 at Prof. Dr. W. Z. Johannes Hospital, Kupang, Indonesia, involving 60 patients undergoing elective CS under spinal anesthesia, randomly assigned into two groups. The PI group received 400 mg of intravenous ibuprofen post-delivery, followed by 1,000 mg of oral paracetamol and 400 mg of ibuprofen every 8 hours. The PK group was given 30 mg of intravenous ketorolac, followed by 1,000 mg of oral paracetamol and 30 mg of intravenous ketorolac every 8 hours. Pain was assessed using the numeric rating scale (NRS) at 8, 24, and 48 hours postoperatively, while opioid rescue use (NRS > 4) and side effects such as nausea, vomiting, and epigastric pain were also recorded.

RESULTS

Pain scores were significantly lower in the PI group at 8 and 24 hours postoperatively (P < 0.05). No significant difference was found between the groups at 48 hours (P = 0.094). There was no significant difference between the groups (P = 0.656 and P = 0.095) in terms of total morphine rescue dose or the incidence of postoperative nausea and vomiting (PONV). The incidence of epigastric pain was significantly lower in the PI group (P = 0.038).

CONCLUSION

PI may represent a more favorable option for early postoperative pain control and lower epigastric pain effect, pending further validation in larger, multicenter trials. Both combinations had similar outcomes in terms of opioid use and PONV.