Comparison of Intravenous Ibuprofen Versus Intravenous Ketorolac in Acute Postoperative Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Non-steroidal anti-inflammatory drugs (NSAIDs) are popularly used in the management of acute postoperative pain. Intravenous (IV) ketorolac has been used for several years for this purpose. Recently, IV ibuprofen has been introduced for the management of postoperative pain. This review aims to compare the efficacy of these two NSAIDs in managing acute postoperative pain. After registering the protocol in the International Prospective Register of Systematic Reviews (PROSPERO), databases like PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid were searched using relevant keywords. Twenty-four-hour opioid consumption was the primary outcome. Pain scores, patient satisfaction, rescue analgesia requirements, and adverse events were the secondary outcomes assessed. Out of 124 articles that were retrieved, six articles fulfilled the inclusion criteria. The Risk of Bias 2 (RoB-2) was used for risk of bias assessment, Review Manager (RevMan) was used for a quantitative meta-analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the strength of evidence. The risk of bias was high in all categories. The 24-hour opioid requirement, which was the primary outcome, was comparable between both groups (mean difference: -4.72; 95% CI: -5.65, -3.80; P=0.79), with significant heterogeneity (I=93%). The secondary outcomes were comparable among both groups. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) strength of evidence was moderate for the pain score at movement and low to very low for other outcomes. Based on the results of this review, the efficacy of IV ibuprofen and IV ketorolac are comparable. However, the findings should be interpreted with caution due to significant clinical and statistical heterogeneity. Well-designed, adequately powered studies need to be conducted to find out the dose, frequency, and type of surgery suitable for various NSAIDs.