1. 2021;24;E1199-E1204The Use of Combination Paracetamol and Ibuprofen in Postoperative Pain after Total Knee Arthroplasty, a Randomized Controlled Trial
   Randomized Controlled Trial
   Andri Marulitua Lubis, MD, PhD, Samuel Maruanaya, MD, Aida Rosita Tantri, MD, PhD, Ludwig Andribert Powantia Pontoh, MD, PhD, and Nadia Nastassia Primananda Putri Shah Ifran, MD.

BACKGROUND: Adequate pain management has an important role in supporting early ambulation after total knee arthroplasty (TKA). Multimodal analgesia is one of the modalities of overcoming postoperative pain. The use of a combination of paracetamol and ibuprofen is expected to reduce the total morphine requirement after TKA.

OBJECTIVES: The use of a combination of paracetamol and ibuprofen to reduce morphine requirement after TKA, to provide adequate pain management and early ambulation.

STUDY DESIGN: Patients scheduled for total knee arthroplasty who met the requirements for inclusion criteria were consented and randomized using randomizer.org in a 1:1:1 ratio to receive either combination paracetamol iv and ibuprofen iv (Group II), paracetamol iv only (Group II), or ibuprofen iv only (III).

SETTING: Thirty-six patients aged 63-68 years who underwent TKA were included in this study.

METHODS: All patients were divided into 3 groups. Group I received paracetamol 1 g and ibuprofen 800 mg, group II received 1 g paracetamol iv and 100 mL normal saline, group III received 800 mg ibuprofen iv and 100 mL normal saline, 10 minutes before the end of surgery and every 6 hours up to 24 hours. Total morphine consumption, pain score (resting, walking, knee flexion), and 2 minute-length walking tests were measured in hour 24 postoperative. Data were analyzed with SPSS 16.0.

RESULTS: Median of total morphine consumption between 3 groups respectively was 7.5 (3.0-36.0) mg vs 15.0 (4.5-28.5) mg vs 9.0 (0.0-24.0) mg with no difference (P = 0.391). Mean of pain score at walking phase respectively was 4.8 ± 0.5 vs 7.3 ± 1.2 vs 5.6 ± 0.5 (hour 24, P < 0.01). Medians of 2-Minute Walking Test respectively were 6.0 (2-16) meters vs 0.0 (0-4) meters vs 0.0 (0-4) meters (hour 24, P  < 0.01).

LIMITATIONS: The total morphine requirement measured in this study illustrates the consumption of morphine in resting phase.

CONCLUSION: The combination of paracetamol and ibuprofen is better in reducing the total morphine requirement after TKA when compared with the administration of paracetamol injection alone or ibuprofen injection alone. Combination paracetamol injection and ibuprofen injection also provides adequate pain management in order to help early ambulation.

KEY WORDS: Multimodal analgesia, paracetamol, ibuprofen, TKA, morphine consumption, pain score