Comparative efficacy and safety of intravenous ibuprofen and paracetamol in moderate-to-severe acute postoperative pain: systematic review and meta-analysis
Abstract
Background.
Acute postoperative pain remains a significant clinical challenge despite advances in anaesthesiology. Multimodal analgesia with non-opioid analgesics is the standard of care. Intravenous (IV) ibuprofen and IV paracetamol are widely used, but their comparative efficacy has been insufficiently studied.
Objective.
To perform a systematic review and indirect comparison (network meta-analysis) of the efficacy and safety of IV ibuprofen versus IV paracetamol in adult patients with moderate-to-severe acute postoperative pain.
Methods.
A systematic search was conducted in PubMed/MEDLINE, Cochrane Central, Google Scholar, Semantic Scholar up to November 2025. Inclusion criteria: randomized controlled trials (RCTs) in adults comparing IV ibuprofen (800 mg q6h) or IV paracetamol (1000 mg q6h) combined with opioids against a control (placebo + opioids). The primary outcome was pain intensity reduction measured by the area under the curve of the visual analogue scale on movement (AUC–VASM) over 6–24 h. Secondary outcomes were opioid consumption, incidence of any adverse events (AEs), and postoperative nausea and vomiting (PONV). Risk of bias was assessed with the RoB 2.0 tool. Pairwise and network meta-analyses were performed using a random-effects model (DerSimonian — Laird). We calculated standardized mean differences (SMD) and risk ratios (RR) with 95 % confidence intervals (CI). Heterogeneity was evaluated with the I
2
statistic. A frequentist network meta-analysis was…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 879 participants or records.
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