Acetaminophen, Ibuprofen Combo Lessens Morphine Use After Hip Replacement

In the first 24 hours after total hip arthroplasty, acetaminophen (paracetamol) plus ibuprofen significantly decreased patient-controlled morphine consumption compared with acetaminophen alone.

“However, the combination did not result in a clinically important improvement over ibuprofen alone,” researchers added, “suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia.”

Researchers published their findings February 12, 2019, in JAMA.

The blinded trial included 559 patients, average age 67, in Denmark randomized to one of four nonopioid oral analgesic regimens, which began 1 hour before total hip arthroplasty and continued every 6 hours for 24 hours afterward: (1) acetaminophen 1000 mg plus ibuprofen 400 mg; (2) acetaminophen 1000 mg plus matched placebo; (3) ibuprofen 400 mg plus matched placebo; or (4) half-strength acetaminophen 500 mg plus ibuprofen 200 mg.

Median 24-hour morphine consumption was 20 mg with acetaminophen plus ibuprofen compared with 26 mg for ibuprofen alone, according to the study. Morphine consumption with acetaminophen alone was a median 36 mg; it was 28 mg with the half-strength doses of acetaminophen plus ibuprofen.

The difference in morphine consumption between the full-strength acetaminophen-plus-ibuprofen group and the ibuprofen-alone group was 6 mg.

Serious adverse events occurred in 15% of patients who received ibuprofen as part of their regimen compared with 11% of patients who received acetaminophen alone, researchers reported.

—Jolynn Tumolo

Reference

Thybo KH, Hägi-Pedersen D, Dahl JB, et al. Effect of combination of paracetamol (acetaminophen) and ibuprofen vs either alone on patient-controlled morphine consumption in the first 24 hours after total hip arthroplasty: the PANSAID randomized clinical trial. JAMA. 2019;321(6):562-571.