Premedication with Intravenous Ibuprofen Improves Recovery Characteristics and Stress Response in Adults Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

• Published in: Pain medicine (Malden, Mass.) Mass.), 2016-06, Vol.17 (6), p.1163-1173
• Main Authors: Le, Vanny, Kurnutala, Lakshmi, Schiano Di Cola, Joseph, Ahmed, Khaja, Yarmush, Joel, Daniel Eloy, Jean, Shapiro, Michael, Haile, Michael, Bekker, Alex
• Format: Article
• Language: English
• Subjects: Catecholamines; Cholecystectomy; Cytokines; Drug dosages; Epinephrine; Evidence-based medicine; Fatigue; Hormones; Ibuprofen; IL-1β; Immune response; Inflammation; Interleukin 10; Interleukin 2; Interleukin 6; Intravenous administration; Laparoscopy; Mental depression; Nonsteroidal anti-inflammatory drugs; Norepinephrine; Patients; Recovery (Medical); Stress response; Surgery; Tumor necrosis factor-α; γ-Interferon
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnv113

Abstract Objective(s). Examine the effect of preoperative dose of IV ibuprofen on stress response and postoperative recovery in laparoscopic cholecystectomy patients. Design. Prospective, randomized, controlled, double-blind, multicenter trial. Setting. Three university-based, tertiary care hospitals. Subjects. Fifty-five adults, ASA 1, 2, or 3 scheduled for laparoscopic cholecystectomy were given a single preoperative dose of placebo or IV ibuprofen 800 mg. Methods. Neurobehavioral assessments were evaluated preoperatively, in PACU, POD 1, and POD 3, using the 40-item Quality of Recovery questionnaire (QoR40), 9-item Modified Fatigue Severity Scale (MFSS), and 15-item Geriatric Depression scale (GDS). Blood samples were taken for cytokines (TNF-alpha, IL-1β, IL-2, IL-6, IL-10, IFNγ), cortisol, CRP, epinephrine, and norepinephrine prior to the administration of study drug/placebo, intraoperatively, and after surgery. Results. Global QoR40 scores remained at baseline for ibuprofen patients but significantly decreased in the placebo group. Severity of fatigue increased in patients receiving placebo but had no change with ibuprofen. The placebo group had lower GDS scores on POD 3. Epinephrine and norepinephrine were significantly lower intraoperatively for the ibuprofen group. Cortisol decreased postoperatively in the ibuprofen group. There was an impact of drug treatment on the immune response, as seen by an increase in TNFα and an increase in IL-10 when compared with placebo. Conclusions. Our results suggest the addition of NSAIDs may improve the overall quality of recovery, postsurgical fatigue, and early postoperative outcomes. Preoperative administration of IV ibuprofen modulates the stress and inflammatory response, as demonstrated by a decrease in the level of catecholamines, cortisol, and cytokines. Trial registration: Clinicaltrials.gov identifier: 01938040.