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Paracetamol plus ibuprofen may reduce morphine consumption after THA
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In the first 24 hours after total hip arthroplasty, use of paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone, according to results published in JAMA.
Kasper Højgaard Thybo , MD, and colleagues randomly assigned 559 patients undergoing THA to receive 1,000 mg of paracetamol (acetaminophen) plus 400 mg of ibuprofen, 1,000 mg of acetaminophen plus matched placebo, 400 mg of ibuprofen plus matched placebo or half-strength acetaminophen plus ibuprofen orally starting 1 hour before surgery and then every 6 hours for 24 hours postoperatively. The primary outcomes included 24-hour morphine consumption using patient-controlled analgesia in pairwise comparisons between the four groups and the proportion of patients with one or more serious adverse events within 90 days.
Results showed a median 24-hour morphine consumption of 20 mg in the acetaminophen plus ibuprofen group, 36 mg in the acetaminophen alone group, 26 mg for the ibuprofen alone group and 28 mg for the half-strength acetaminophen plus ibuprofen group. After adjustment for multiple comparisons and the co-primary outcomes, researchers found no statistically significant difference in morphine consumption for the acetaminophen plus ibuprofen group vs. the half-strength acetaminophen plus ibuprofen group, or for the acetaminophen alone group vs. the ibuprofen alone group. According to results, the ibuprofen alone group also had no significant differences when compared with the half-strength acetaminophen plus ibuprofen group. Researchers noted a relative risk of 1.44 for serious adverse events, with serious adverse events occurring in 15% and 11% of patients in the ibuprofen alone and acetaminophen alone groups, respectively.
“In this multicenter study, we found that when combining paracetamol and ibuprofen the first 24-hours after hip arthroplasty, the need for supplementary opioids, pain levels and risk of opioid-associated adverse effects were lower as compared with each drug alone,” Thybo told Healio.com/Orthopedics. “However, the reduction of opioid usage compared to ibuprofen treatment alone was not above the pre-specified minimal clinically important difference of 10 mg morphine per 24 hours. Further, we did not find that short-term NSAID treatment significantly increased number of serious adverse events within 90 days. Based on our study we would recommend short-term analgesic treatment with both paracetamol and ibuprofen.” – by Casey Tingle
Disclosures: Thybo reports he receives grants from the Danish Society of Anaesthesiology and Intensive Care Medicine, Sophus Johansens Fund, Region Zealand Health Scientific Research Foundation, the local research foundation at Naestved-Slagelse-Ringsted Hopsitals, the A.P. Møller Foundation for the Advancement of Medical Science, Aase og Ejnar Danielsens Fund and the Grosserer Christian Andersen og Hustru Ingeborg Andersen, f. Schmidts legat fund, and was employed as a doctoral student while he was the primary investigator of this trial. Please see the full study for a list of all other authors’ relevant financial disclosures.
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Thybo KH, et al. JAMA. 2019;doi:10.1001/jama.2018.22039.
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