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

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Bibliographic Details
Title:	The impact of intravenous ibuprofen-paracetamol vs. ketorolac-paracetamol on coagulation and inflammation: implications for analgesia in hypertensive patients undergoing surgery.
Alternate Title:	El impacto de ibuprofeno-paracetamol intravenoso vs. ketorolaco-paracetamol en la coagulación y la inflamación: implicaciones para la analgesia en pacientes hipertensos sometidos a cirugía.
Authors:	Maarif, Muhammad Khaerul¹ khaerulmaarif19@yahoo.com, Takdir Musba, A. M.² takdir1974@yahoo.com, Datu, Madonna D.³ madonnadatu6@gmail.com, Gaus, Syafruddin³ udhingaus@hotmail.com, Wirawan, Nur Surya² acoanestesi@yahoo.com, Adil, Andi³ adil_zanetti@yahoo.co.id
Source:	Revista Latinoamericana de Hipertensión. 2025, Vol. 20 Issue 8, p615-621. 7p.
Subjects:	BLOOD coagulation, INFLAMMATION, ANALGESIA, HYPERTENSION, ACETAMINOPHEN, KETOROLAC, IBUPROFEN, GYNECOLOGIC surgery
Abstract (English):	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 ketorolacparacetamol, 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 proinflammatory 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. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	El dolor posoperatorio tras cirugía ginecológica sigue representando un desafío clínico significativo, ya que muchas pacientes aún experimentan dolor de moderado a intenso con los tratamientos estándar. La posibilidad de complicaciones, como el sangrado, subraya aún más la necesidad de estrategias analgésicas optimizadas que equilibren eficacia y seguridad. Este estudio evaluó dos regímenes multimodales: ibuprofeno-paracetamol intravenoso versus ketorolaco-paracetamol, comparando su impacto en la intensidad del dolor, los parámetros de coagulación y los niveles de interleucina-6 (IL-6). En un ensayo aleatorizado doble ciego con 40 pacientes, ambas combinaciones proporcionaron un control del dolor equivalente y efectivo, sin observarse diferencias significativas en las puntuaciones de dolor ni en el tiempo de coagulación entre los grupos. Sin embargo, un hallazgo clave fue que el régimen basado en ketorolaco provocó una prolongación significativa del tiempo de sangrado a las 24 y 48 horas posoperatorias. Por el contrario, la combinación basada en ibuprofeno demostró un efecto antiinflamatorio más potente, resultando en niveles significativamente más bajos de la citocina proinflamatoria IL-6. En consecuencia, si bien ambos regímenes son eficaces para la analgesia, la elección entre ellos debe depender del perfil de riesgo del paciente; el ketorolaco puede suponer un mayor riesgo de sangrado, mientras que el ibuprofeno puede ofrecer un mejor control de la respuesta inflamatoria quirúrgica. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
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 ketorolacparacetamol, 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 proinflammatory 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. [ABSTRACT FROM AUTHOR]
ISSN:	18564550
DOI:	10.5281/zenodo.17113732