Postoperative Analgesic Effects of Pre-emptive Intravenous Paracetamol Versus Ibuprofen in Laparoscopic Cholecystectomy: A Randomized, Double-Blind Study.

Introduction Effective postoperative pain control is essential for enhanced recovery and improved patient satisfaction following laparoscopic cholecystectomy. Pre-emptive administration of non-opioid analgesics, such as intravenous paracetamol and ibuprofen, has been incorporated into multimodal analgesic strategies to reduce postoperative pain and opioid consumption. This study compared the analgesic efficacy and safety of pre-emptive intravenous paracetamol and intravenous ibuprofen in patients undergoing elective laparoscopic cholecystectomy. Objective The primary objective of this study was to compare postoperative pain intensity between pre-emptive intravenous paracetamol and intravenous ibuprofen using the Visual Analogue Scale (VAS) at the end of surgery and at 2, 6, 12, 18, and 24 hours postoperatively. Secondary objectives included comparison of perioperative haemodynamic parameters (heart rate, mean arterial pressure, and peripheral oxygen saturation) and assessment of drug-related adverse effects, including postoperative nausea and vomiting. Methodology This prospective, randomized, double-blind, parallel-group comparative study was conducted in the Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India, between August 2023 and January 2025. Ninety patients aged 18-60 years with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated into two equal groups. Group P received intravenous paracetamol 2 g, while Group I received intravenous ibuprofen 800 mg, each diluted in 200 mL normal saline and infused over 30 minutes before induction of anaesthesia. Postoperative pain was assessed using the Visual Analogue Scale, and haemodynamic variables and adverse events were recorded for 24 hours. Results Baseline demographic and clinical characteristics were comparable between the two groups. Postoperative VAS scores improved over time in both groups, with a significantly greater reduction in pain scores in the ibuprofen group than in the paracetamol group (p < 0.001). Heart rate and other haemodynamic parameters remained comparable between groups throughout the study, with no significant difference in overall heart rate trends (p = 0.060). Although intravenous ibuprofen provided superior analgesia, it was associated with a higher incidence of postoperative nausea and vomiting. Conclusion Pre-emptive intravenous ibuprofen provided superior postoperative analgesia compared with intravenous paracetamol following laparoscopic cholecystectomy. However, because ibuprofen was associated with a higher incidence of adverse effects, it should be selected with attention to patient characteristics and clinical risk factors.