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| |  Intravenous Ibuprofen Can Reduce Opioid Use After Knee, Hip Surgery: Presented at AAOS By Sophie Bainbridge NEW ORLEANS -- March 14, 2010 -- Pre- and postoperative intravenous (IV) ibuprofen resulted in a significant decrease in pain scores and morphine usage in orthopaedic surgical patients, researchers said here on March 11 at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). “The drug provides a novel way of administering a known and trusted compound -- ibuprofen,” said lead investigator, Neil Singla, MD, Lotus Clinical Research, Inc., Pasadena, California. “Avoiding or reducing perioperative narcotic load can benefit patients by reducing common narcotic-related side effects, such as itching, nausea, and constipation.” Although oral nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to block pain and inflammation, its use is not practical during the immediate pre- and postoperative periods. Injectable opioid analgesia does not block the inflammatory component of pain, and the use of these agents is associated with serious side effects. In the study, which was conducted at 6 centres in the United States and 2 centres in South Africa between June 2007 and April 2008, investigators randomly assigned 185 patients undergoing elective knee or hip replacement, reconstruction, or arthroplasty to receive either 800 mg intravenous ibuprofen or placebo every 6 hours. In addition, all patients had access to morphine with a patient-controlled analgesia pump at a dose of 1 to 2 mg every 5 minutes. The patient’s self-assessment of pain using a visual analogue scale (VAS), as well as the amount of morphine they used during the postoperative period, was used to gauge the efficacy of IV ibuprofen. Twenty-four hours after administration, there was a 26% reduction in the mean VAS- area under the curve (VAS-AUC) score with movement in patients receiving IV ibuprofen (P < .001); a 32% reduction in mean VAS-AUC at rest, and a 20.2% reduction in mean verbal rating scale scores (P < .001). In addition to experiencing less pain, there was a 31% reduction in mean morphine consumption in patients receiving IV ibuprofen (P < .001). Compared with placebo, treatment with IV ibuprofen did not result in more adverse events, serious adverse events, or abnormal lab measurements, the investigators noted. “The reduction in morphine consumption is encouraging,” said Dr. Singla. “As patients get more elderly, physicians become reluctant to order opioid therapy because of fears of dementia, depressed respiration, and other adverse events. Yet, you’ve got to treat their pain. IV ibuprofen is something the clinician can use as part of multimodal therapy, in order to reduce opioids and still achieve good pain relief.” Funding for this study was provided by Cumberland Pharmaceuticals. [Presentation title: A Clinical Trial of Intravenous Ibuprofen for Treatment of Pain in Orthopedic Surgical Patients. Abstract P133]
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