Efficacy and Safety of Multimodal Analgesia in Bariatric Surgery: Ketorolac vs. Ibuprofen

BACKGROUND: Adequate postoperative pain control after bariatric laparoscopic resection is a key factor for rapid recovery and reduced risk of complications. Published data provide conflicting results regarding the comparative efficacy of the nonsteroidal anti-inflammatory drugs ibuprofen and ketorolac as components of multimodal analgesia in perioperative pain management.

AIM: The work aimed to compare the efficacy and safety of perioperative analgesia with ibuprofen and ketorolac within a multimodal approach in patients undergoing elective bariatric surgery.

METHODS: A prospective analysis included data from 90 patients divided into two groups: the ibuprofen group (n = 45) and the ketorolac group (n = 45). The primary outcome was pain intensity assessed using the visual analog scale at rest and during movement 0.5, 2, 4, 6, 12, and 24 hours after surgery. Secondary outcomes included time to first analgesic request, need for rescue analgesia, bowel function (time to first flatus), mobilization (time to ambulation), quality of recovery according to the QoR-15 scale, and incidence of adverse effects. Statistical analysis was performed using the t test or Mann–Whitney U test for continuous variables and Fisher exact test for categorical variables.

RESULTS: The groups were comparable in age, body mass index, ASA physical status, and duration of surgery (p > 0.05). At rest, ibuprofen demonstrated significant benefits after 4 hours (median visual analog scale [VAS] score, 32 mm vs 37 mm; p = 0.0004) and 12 hours (29 mm vs 36 mm; p = 0.020), and during movement after 4 hours (35 mm vs 44 mm; p = 0.0002) and 12 hours (33 mm vs 45 mm; p = 0.0097). The frequency of rescue analgesia was lower in the ibuprofen group (26.7٪ vs 46.7٪; p = 0.049), and the time to the first analgesic dose was longer (median, 124 min vs 72 min; p = 0.008). Bowel function recovery occurred earlier (15 h vs 23 h; p < 0.0001), and the quality of recovery measured by the QoR-15 scale was higher after 48 and 72 hours (p = 0.0002; p < 0.0001, respectively). The incidence of adverse effects was low and did not differ significantly between groups.

CONCLUSION: The preventive use of ibuprofen as part of multimodal analgesia provides earlier and more pronounced pain reduction, decreases the need for rescue analgesia, and accelerates bowel function recovery and overall well-being without increasing the risk of complications compared with ketorolac.