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Prior ibuprofen exposure does not augment opioid drug potency or modify opioid requirements for pain inhibition in total hip surgery

[L’exposition préalable à l’ibuprofène n’augmente pas l’effet des opiacés ou ne modifie pas les besoins d’opiacés pour l’analgésie de l’arthroplastie totale de la hanche]

Marian L.T. Bugter, MD^*, Ris Dirksen, MD PhD^*, Khem Jhamandas, PhD, Robert Slappendel, MD PhD^*, Eric W.G. Weber, MD^* and Brian Milne, MD FRCP(C)

^* From the Department of Anaesthesiology, Sint Maartensklinick, Nijmegen, the Netherlands; and
the Departments of Pharmacology Toxicology; and
Anaesthesiology, Queen’s University, Faculty of Health Sciences, Kingston, Ontario, Canada.

Address correspondence to: Dr. Marian L.T. Bugter, Department of Anaesthesiology, Sint Maartensklinick, P.O. Box 9011, 6500 GM Nijmegen, the Netherlands. Phone: 024 3659911; Fax: 024 3659487; E-mail: m.bugter{at}maartenskliniek.nl

Purpose: In previous animal studies, a prior exposure to non-steroidal anti-inflammatory drugs (NSAID) augmented opioid drug potency. This study was designed to answer the question whether a similar effect can be attained in man. The objective was to use NSAID for preoperative pain reduction and at the same time use the NSAID exposure to reduce opioid requirements for pain inhibition in major orthopedic surgery.

Methods: In this double-blind, randomized study, 50 patients scheduled for total hip surgery were included. Patients of Group I received a placebo drug three times a day two weeks before surgery, and those allocated to Group II received ibuprofen (600 mg) three times a day. For surgical anesthesia, all patients received intrathecal bupivacaine 20 mg plus 0.1 mg morphine in a total volume of 4 mL.

Results: The preoperative or postoperative visual analogue scale pain scores or the amount of iv morphine showed no differences between the two groups in the first 24 hr after surgery. The median total blood loss in the ibuprofen group was 1161 mL vs 796 mL in the placebo group (P < 0.01).

Conclusion: Pretreatment with ibuprofen before major hip surgery does not improve the pain scores or reduce morphine requirement but significantly increases blood loss. Considering the presence of relevant adverse effects, pretreatment with a non-selective NSAID is not recommended.