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.