The impact of intravenous ibuprofen-paracetamol vs. ketorolac-paracetamol on coagulation and inflammation: implications for analgesia in hypertensive patients undergoing surgery

Abstract

Postoperative pain following gynecological surgery continues to pose a significant clinical challenge, as many patients still experience moderate-to-severe pain with standard treatments. The potential for complications like bleeding further underscores the need for optimized analgesic strategies that balance efficacy with safety. This study evaluated two multimodal regimens: intravenous ibuprofen-paracetamol versus ketorolac-paracetamol, comparing their impact on pain intensity, coagulation parameters, and interleukin-6 (IL-6) levels. In a double-blind randomized trial involving 40 patients, both combinations provided equivalent and effective pain control, with no significant difference in pain scores or clotting time observed between the groups. However, a key finding was that the ketorolac-based regimen caused a significant prolongation of bleeding time at 24 and 48 hours post-surgery. Conversely, the ibuprofen-based combination demonstrated a stronger anti-inflammatory effect, resulting in significantly lower levels of the pro-inflammatory cytokine IL-6. Consequently, while both regimens are effective for analgesia, the choice between them should be influenced by the patient's risk profile; ketorolac may pose a greater bleeding risk, whereas ibuprofen may offer superior control of the surgical inflammatory response.

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