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
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 60 participants or records.
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