Pre-Emptive Intravenous Ibuprofen Versus Paracetamol For Postoperative Analgesia In Percutaneous Nephrolithotomy - A Prospective Comparative Study

Background: Patients who undergo percutaneous nephrolithotomy (pcnl) procedure experience postoperative pain at moderate to severe levels because the operation causes renal capsular distension and parenchymal damage and tract expansion and nephrostomy tube insertion. Pre-emptive analgesia provides effective pain relief which decreases central sensitization and decreases postoperative opioid use and enhances patient recovery. Hospitals use intravenous paracetamol and ibuprofen as non-opioid pain medication, but research on their effectiveness to prevent pain during pcnl procedures remains scarce. Objective: The study aimed to compare the effectiveness of pre-emptive intravenous ibuprofen and paracetamol for postoperative pain relief in patients who undergo pcnl operations under general anaesthesia. Methods: We used a single-centre hospital location to conduct a forward-looking study which compared two groups of adult patients who required elective pcnl operations under general anaesthesia. The participants received random assignment (1:1) that allowed them to choose between intravenous ibuprofen 400 mg (group i) or intravenous paracetamol 1000 mg (group ii) which they would take 30 minutes before their surgery started. The main goal of the study measured total opioid usage by patients during their first day after surgery. The study measured secondary outcomes through visual analogue scale (vas) pain scores which assessed pain during rest and after movement as well as the time required to receive first pain relief and patient satisfaction and negative effects. Results: Sixty patients were equally allocated to the ibuprofen (n = 30) and paracetamol (n = 30) groups. The two groups showed comparable baseline demographic and perioperative characteristics (all p > 0.05). The ibuprofen group showed significantly lower total 24-hour postoperative opioid consumption compared to the paracetamol group (78.2 ± 14.6 mg vs 112.4 ± 18.9 mg; p < 0.001). The ibuprofen group maintained lower vas pain scores throughout all postoperative time points (p < 0.001). The time to first rescue analgesia was significantly longer with ibuprofen (182.6 ± 28.4 min vs 118.3 ± 24.7 min; p < 0.001). The ibuprofen group achieved higher patient satisfaction scores while both groups experienced a low rate of adverse effects which remained similar between them. Conclusion: The study found that preemptive single dose intravenous ibuprofen 400mg gave better pain relief to patients who underwent pcnl surgery than standard dose paracetamol while maintaining same level of safety.