Postoperative Pain Reduced With Intravenous Preoperative Ketorolac vs Ibuprofen

Researchers assessed the effect of preoperative intravenous NSAIDs on postoperative pain relief in patients who underwent laparoscopic cholecystectomy.

Compared with ibuprofen, preoperative intravenous (IV) ketorolac reduced immediate postoperative pain and analgesic requirement in the recovery room, according to results of a single center retrospective study published in Annals of Hepato-Biliary-Pancreatic Surgery.

The aim of the study was to determine the effect of preoperative IV nonsteroidal anti-inflammatory drugs (NSAIDs) – ketorolac vs ibuprofen – on postoperative pain relief in patients after laparoscopic cholecystectomy.

Patient records at the Yonsei University College of Medicine in South Korea were analyzed. Between 2019 and 2020, patients undergoing surgery for chronic cholecystitis, gallbladder stones or polyps, and suspicious gallbladder cancer were evaluated for postoperative pain control and need for rescue medication. Participants received either 30 mg of preoperative IV ketorolac or 400 mg of IV ibuprofen. In addition, all patients could receive 50 mg tramadol for breakthrough pain.

The primary study outcome was immediate postoperative pain score in the recovery room.

A total of 51.2% and 53.2% of the ketorolac and ibuprofen cohorts were women; mean age of participants was 53.8±14.4 and 51.2±12.6 years, respectively; 12.8% and 10.4%, respectively, were undergoing emergency surgery; and preoperative visual analog scale (VAS) pain scores were 1.46±0.52 and 1.40±0.51, respectively.

Postoperative pain scores in the recovery room were 4.61±1.23 with ketorolac and 5.09±1.45 with ibuprofen (P =.027). Fewer patients receiving ketorolac vs ibuprofen required rescue medication in the recovery room (20.9% vs 36.4%; P =.036).

Researchers did not observe differences between the ketorolac and ibuprofen groups in percentage of patients who received analgesics during anesthesia (60.5% vs 59.7%; P >.999), dose of analgesics during anesthesia (mean, 51.54 mg vs 51.09 mg; P =.786), total number of rescue analgesics during first 24 hours (mean, 1.23 vs 1.28; P =.770), peak pain score (mean, 5.82 vs 6.11; P =.113), and pain score at discharge (mean, 2.23 vs 2.11; P =.320), respectively.

One of the study limitations included the lack of assessing long-term postoperative pain outcomes.

Researchers concluded, “Further prospective randomized controlled trials are needed to give us more conclusive evidence for the use of preoperative IV NSAIDs.”


Lee GG, Park JS, Kim HS, Yoon DS, Lim JH. Clinical effect of preoperative intravenous non-steroidal anti-inflammatory drugs on relief of postoperative pain in patients after laparoscopic cholecystectomy: intravenous ibuprofen vs. intravenous ketorolac. Ann Hepatobiliary Pancreat Surg. Published online March 10, 2022. doi:10.14701/ahbps.21-151