Comparison of Ibuprofen and Paracetamol combination with Ketorolac and Paracetamol combination in patients undergoing gynecologic surgery: a review of pain level, coagulation profile, and interleukin-6 levels

Abstract

Introduction. Postoperative pain management in gynecological surgery remains a significant challenge, with many patients experiencing moderate-to-severe pain despite standard analgesic interventions. The risk of complications, such as bleeding and prolonged recovery, is heightened by the use of certain analgesics, emphasizing the need for optimal pain management strategies. The objective was to compare the efficacy of two multimodal analgesic regimens: Ibuprofen– Paracetamol and Ketorolac- Paracetamol on pain, coagulation and IL-6 levels. Materials and methods. A double-blind randomized trial was conducted with 40 patients who underwent gynecological surgery. Group 1 received IV Ibuprofen (400 mg) + Paracetamol (1000 mg); Group 2 received IV Ketorolac (30 mg) + Paracetamol (1000 mg). Pain (NRS), clotting time (CT), bleeding time (BT), and IL-6 were assessed at 6, 24, and 48 hours postoperatively. Results. Pain scores and CT did not differ significantly between the groups. The Ketorolac group showed a significant increase in BT at 24 and 48 hours (p < 0.05), while the Ibuprofen group had significantly lower IL-6 levels at 24 hours (p < 0.05). Conclusion. Both regimens were equally effective in pain control. However, Ketorolac- Paracetamol significantly prolonged the bleeding time, whereas Ibuprofen-Paracetamol was more effective in reducing inflammation by lowering IL-6 levels. These differences should be considered, especially in patients at risk of bleeding.

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