The Analgesic Effects of the Addition of Intravenous Ibuprofen to a Multimodal Analgesia Regimen for Pain Management After Pediatric Cardiac Surgery: A Randomized Controlled Study

Abstract

Objective: Intravenous ibuprofen is used to control fever and pain. This study aimed to assess the analgesic effects of the addition of intravenous ibuprofen to a multimodal analgesia regimen for pain management after pediatric cardiac surgery.

Design: A randomized, controlled, double-blinded, superiority study.

Setting: University hospital.

Participants: Seventy-eight pediatric patients who underwent open cardiac surgery using midline sternotomy incision were screened for eligibility; 10 patients were excluded, leaving 68 patients (34 patients in the ibuprofen group and 34 patients in the control group) for final data analysis.

Interventions: Patients were randomly allocated to either the ibuprofen group, in which the patient received intravenous ibuprofen infusion of 10 mg/kg/6 hours for 24 hours, or the control group, in which the patient received a placebo 0.9% saline.

Measurements and main results: The primary endpoint was the 24-hour postoperative fentanyl consumption, and the secondary endpoints were postoperative modified objective pain score and the incidence of ibuprofen-related side effects (eg, vomiting, epigastric pain, bleeding, and renal dysfunction). The mean total fentanyl consumption (μg/kg) during the first postoperative 24 hours after extubation was significantly lower (p<0.001) in the ibuprofen group (3.5 ± 1.3) than the control group (5.1 ± 1.4). The median postoperative modified objective pain score was significantly lower (p < 0.05) in the ibuprofen group than the control group at 0 hours, 2 hours, 12 hours, 16 hours, 20 hours, and 24 hours postoperatively. Ibuprofen did not cause significant increases in the incidences of bleeding, epigastric pain, and vomiting. Postoperative renal dysfunction was not reported in any patient.

Conclusions: The addition of intravenous ibuprofen to a multimodal analgesia regimen for pain management after pediatric cardiac surgery improved postoperative analgesia in terms of reduction of opioid consumption and pain scores.

Keywords: analgesia; cardiac surgical procedures; child, fentanyl; ibuprofen; sternotomy.