Implications for IVIB in clinical practice
Treatment of postoperative pain continues to be a challenge. Appropriate implications of perioperative multimodal analgesia may contribute to the relieve of psychological distress, anxiety, sleeplessness and helplessness, impaired postoperative rehabilitation, potentially long-term psychological consequences, and the possibility of chronic postsurgical pain (54-56). Acetaminophen and NSAIDs have been evaluated as a fundamental part of multimodal analgesia in patients also receiving opioids without contraindications (such as patients undergoing coronary artery bypass graft surgery, with a history of active peptic ulcers, bleeding, or gastrointestinal bleeding or perforation following the use of NSAIDs) (3, 57, 58).
Several studies have indicated that there was no obvious difference between intravenous and oral administration in acetaminophen and NSAIDs (59, 60). Intravenous route, with a higher cost, is preferred in appropriate patients who were unable to take anything by mouth early in the perioperative period (61). In a regional investigation of the United Kingdom, intravenous NSAIDs administration was the preferred route of analgesics in the perioperative period largely owing to its reliability and speed of onset (62).
The effect of antipyretic and analgesic of ibuprofen primarily by inhibiting cyclooxygenase (COX), and ibuprofen has varying degrees of reversible and competitive inhibitory effects on COX-1 (88.7%) and COX-2 (71.4%) (63). IVIB has a higher (twice) maximum blood concentration and shorter time to peak (0.11h vs. 1.5h) than oral dosage forms, but the elimination half-life of IVIB and oral ibuprofen did not differ (approximately 2 hours) (64-66). IVIB thereby plays a vital role in patients requiring acute analgesia and rapid hypothermia. Nevertheless, considering the limited types of intravenous acetaminophen and NSAIDs on the market, there is lack of head-to-head studies comparing the efficacy and safety among them. Our review found that IVIB might benefit analgesic management in pain control, rescue analgesics, and the risk of nausea and vomiting, which fill in the gap in this area.